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Intravenous thrombolysis in stroke after dabigatran reversal with idarucizumab: case series and systematic review
- Source :
- Journal of Neurology, Neurosurgery & Psychiatry. 90:619-623
- Publication Year :
- 2018
- Publisher :
- BMJ, 2018.
-
Abstract
- Idarucizumab can reverse the effect of the direct thrombin inhibitor dabigatran,1 a non-vitamin K oral anticoagulant (NOAC) available for primary and secondary prevention of cardioembolic stroke due to non-valvular atrial fibrillation. Ischaemic stroke may happen despite ongoing anticoagulation, a contraindication to intravenous thrombolysis (IVT).2 Thus, patients with ischaemic stroke while on dabigatran might be eligible for anticoagulation reversal with idarucizumab to allow IVT. Here, we report our case series and provide a systematic review to define outcomes of such treatment algorithm. Case series of patients undergoing IVT after dabigatran reversal was identified from our stroke registry (online supplementary file 1). Systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines3 and specified protocol (PROSPERO: http://www.crd.york.ac.uk/PROSPERO, registration no. CRD42017060274) (online supplementary file 2). Search strategy, performed on Cochrane Library, MEDLINE, EMBASE and PubMed, can be found in online supplementary file 1. ### Supplementary data [jnnp-2018-318658-supp1.pdf] ### Supplementary data [jnnp-2018-318658-supp2.pdf] ### Data extraction and outcome assessment All available data were collected (online supplementary file 1). According to National Institute of Health Stroke Scale (NIHSS) total score, stroke were divided into mild (1–4), moderate (5–15), moderate to severe (16–20) and severe (21–42 4). Unfavourable outcome was defined as an increase in NIHSS score or death. Additional outcomes included modified Rankin Scale (mRS) at follow-up, symptomatic intracerebral haemorrhage, systemic bleeding, allergic reactions to idarucizumab, recurrent stroke and venous thrombosis during post-acute phase. ### Statistical analysis Statistical analysis was performed with R software using …
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Cochrane Library
Antibodies, Monoclonal, Humanized
Antithrombins
Dabigatran
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Modified Rankin Scale
medicine
Humans
Thrombolytic Therapy
Contraindication
Stroke
Aged
Aged, 80 and over
business.industry
Idarucizumab
Thrombolysis
Middle Aged
medicine.disease
Psychiatry and Mental health
Direct thrombin inhibitor
Emergency medicine
Female
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 1468330X and 00223050
- Volume :
- 90
- Database :
- OpenAIRE
- Journal :
- Journal of Neurology, Neurosurgery & Psychiatry
- Accession number :
- edsair.doi.dedup.....22f1bdf1b6cba67c11b52838d948c404