TY - JOUR
T1 - Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany – A national case collection
AU - Kermer, Pawel
AU - Eschenfelder, Christoph C.
AU - Diener, Hans Christoph
AU - Grond, Martin
AU - Abdalla, Yasser
AU - Althaus, Katharina
AU - Berrouschot, Jörg
AU - Cangür, Hakan
AU - Daffertshofer, Michael
AU - Edelbusch, Sebastian
AU - Gröschel, Klaus
AU - Haase, Claus G.
AU - Harloff, Andreas
AU - Held, Valentin
AU - Kauert, Andreas
AU - Kraft, Peter
AU - Lenz, Arne
AU - Müllges, Wolfgang
AU - Obermann, Mark
AU - Partowi, Someieh
AU - Purrucker, Jan
AU - Ringleb, Peter A.
AU - Röther, Joachim
AU - Rossi, Raluca
AU - Schäfer, Niklas
AU - Schneider, Andreas
AU - Schuppner, Ramona
AU - Seitz, Rüdiger J.
AU - Szabo, Kristina
AU - Wruck, Robert
N1 - Publisher Copyright:
© 2017, © 2017 World Stroke Organization.
PY - 2017/6
Y1 - 2017/6
N2 - Background: Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims: To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage. Methods: Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January to August 2016 were used. Results: Thirty-one patients presenting with signs of stroke received idarucizumab in 22 stroke centers. Nineteen patients treated with dabigatran presented with ischemic stroke and 12 patients suffered from intracranial bleeding. In patients receiving rt-PA thrombolysis following idarucizumab, 79% benefitted from i.v. thrombolysis with a median improvement of five points in NIHSS. No bleeding complications occurred. Hematoma growth was observed in 2 out of 12 patients with intracranial hemorrhage. The outcome was favorable with a median NIHSS improvement of 5.5 points and mRS 0–3 in 67%. Overall, mortality was low with 6.5% (one patient in each group). Conclusion: Administration of rt-PA after reversing dabigatran activity with idarucizumab in case of ischemic stroke is feasible, easy to manage, effective, and appears to be safe. In dabigatran-associated intracranial hemorrhage, idarucizumab has the potential to prevent hematoma growth and improve outcome. Idarucizumab represents a new therapeutic option for patients under dabigatran treatment presenting with ischemic stroke or intracranial hemorrhage.
AB - Background: Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims: To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage. Methods: Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January to August 2016 were used. Results: Thirty-one patients presenting with signs of stroke received idarucizumab in 22 stroke centers. Nineteen patients treated with dabigatran presented with ischemic stroke and 12 patients suffered from intracranial bleeding. In patients receiving rt-PA thrombolysis following idarucizumab, 79% benefitted from i.v. thrombolysis with a median improvement of five points in NIHSS. No bleeding complications occurred. Hematoma growth was observed in 2 out of 12 patients with intracranial hemorrhage. The outcome was favorable with a median NIHSS improvement of 5.5 points and mRS 0–3 in 67%. Overall, mortality was low with 6.5% (one patient in each group). Conclusion: Administration of rt-PA after reversing dabigatran activity with idarucizumab in case of ischemic stroke is feasible, easy to manage, effective, and appears to be safe. In dabigatran-associated intracranial hemorrhage, idarucizumab has the potential to prevent hematoma growth and improve outcome. Idarucizumab represents a new therapeutic option for patients under dabigatran treatment presenting with ischemic stroke or intracranial hemorrhage.
KW - dabigatran
KW - Idarucizumab
KW - intracranial hemorrhage
KW - ischemic stroke
KW - outcome
KW - thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85019221822&partnerID=8YFLogxK
U2 - 10.1177/1747493017701944
DO - 10.1177/1747493017701944
M3 - Article
C2 - 28494694
AN - SCOPUS:85019221822
SN - 1747-4930
VL - 12
SP - 383
EP - 391
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 4
ER -