22. Acute ischemic stroke in a patient taking Dabigatran that was neutralized by idarucizumab before fibrinolysis: The first clinically successful case in Vietnam

Mai Duy Ton, Nguyen Tien Dung, Dao Viet Phuong

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Tóm tắt

Non-vitamin K antagonist oral anticoagulants are used more and more popularly because they are more effective than vitamin K antagonists. Dabigatran is the only non–vitamin K antagonist oral anticoagulant with an antidote, idarucizumab, in Vietnam. The rate of ischemic stroke while using Dabigatran annually is very rare, only 1.75%. We present the first clinical case in Vietnam using Dabigatran with acute ischemic stroke; patient is a 58 years old female, with history of atrial fibrillation, pacemaker, hypertension, old ischemic stroke, using Dabigatran 150mg, 2 tablets/day. The patient was admitted to the Bach Mai Hospital because of weakness on the right side of the body at the 3rd hour, NIHSS of 10 points, CT scans confirmed acute ischemic stroke due to occlusion of the left M3 segment, the last dose of dabigatran was taken 6 hours prior. The patient was given 2 jars of idarucizumab 2.5g, then rt-PA at a dose of 0.6 mg/kg. The patient improved, the NIHSS score was 3 points, and there was no bleeding in the control CT scan. The patient was discharged after 4 days of treatment, with an mRS score of 1.

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Tài liệu tham khảo

1. Raval AN, Cigarroa JE, Chung MK, et al. American Heart Association Clinical Pharmacology Subcommittee of the Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; and Council on Quality of Care and Outcomes Research. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation. 2017;135:e604-e633. doi: 10.1161/CIR.0000000000000477
2. McGrath ER, Eikelboom JW, Kapral MK, et al. Novel oral anticoagulants: A focused review for stroke physicians. Int J Stroke. 2014;9:7178. doi 10.1111/ijs.12158
3. Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-1151. doi: 10.1056/NEJMoa0905561
4. Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e46-e110. doi: 10.1161/STR.0000000000000158
5. Rawal A, Ardeshna D, Minhas S, et al. Current status of oral anticoagulant reversal strategies: A review. Ann Transl Med. 2019;7(17):411. doi: 10.21037/atm.2019.07.101
6. Touzé E, Gruel Y, Gouin-Thibault I, et al. Intravenous thrombolysis for acute ischaemic stroke in patients on direct oral anticoagulants. Eur J Neurol. 2018;25:747-e52. doi: 10.1111/ene.13582
7. Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. European Stroke Journal. 2021;6(1):I-LXII. doi:10.1177/2396987321989865
8. Pollack CV Jr, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373(6):511-520. doi:10.1056/NEJMoa1502000
9. Barber PA, Wu TY, Ranta A. Stroke reperfusion therapy following dabigatran reversal with idarucizumab in a national cohort. Neurology. 2020;94:e1968-e1972.
10. Shahjouei S, Tsivgoulis G, Goyal N, et al. Safety of Intravenous Thrombolysis Among Patients Taking Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis. Stroke. 2020;51(2):533-541. doi:10.1161/STROKEAHA.119.026426
11. Okada T, Yoshimoto T, Wada S, et al. Intravenous Thrombolysis with Alteplase at 0.6 mg/kg in Patients with Ischemic Stroke Taking Direct Oral Anticoagulants. J Am Heart Assoc. 2022;11(19):e025809. doi:10.1161/JAHA.122.025809
12. Meinel TR, Wilson D, Gensicke H, et al. Intravenous Thrombolysis in Patients with Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants. JAMA Neurol. 2023;80(3):233-243. doi:10.1001/jamaneurol.2022.4782
13. Polymeris AA, Meinel TR, Oehler H, et al. Etiology, secondary prevention strategies and outcomes of ischaemic stroke despite oral anticoagulant therapy in patients with atrial fibrillation. Journal of Neurology, Neurosurgery & Psychiatry. 2022;93:588-598.