Neurológia pre prax 5/2018

The first administration of idarucizumab with subsequent intravenous thrombolysis and mechanical thrombectomy in Slovakia (a case report)

Intravenous thrombolysis as the basic causal therapy for acute ischaemic stroke in patients treated with novel oral anticoagulants is contraindicated under certain circumstances. Dabigatran, as the only novel oral anticoagulant, has its specific antidote – the monoclonal antibody idarucizumab. Delivery of the antidote blocks the effect of anticoagulant therapy and allows for administration of causal therapy for hyperacute-stage cerebral ischaemia (thrombolysis, mechanical thrombectomy). We report a case of a 59-year-old female patient treated with dabigatran for a post-ischemic stroke state with a history of atrial fibrillation who had a recurrence, but thrombolysis was contraindicated because of anticoagulant therapy. Following the administration of idarucizumab, we were able to give the patient a thrombolytic drug and, given the finding of occlusion of a large cerebral artery, subsequent mechanical thrombectomy. After providing this treatment, the patient’s condition improved and she could be discharged to home care with an NIHSS of 2b.

Keywords: idarucizumab, thrombolysis, dabigatran, stroke management