Abstract 196: Multicenter Experience of Acute Ischemic Strokes in Patients on Dabigatran Etexilate

Abstract

Objective: Dabigatran etexilate (DE) is an FDA-approved reversible direct thrombin inhibitor to prevent acute ischemic strokes (AIS) in patients with non-valvular atrial fibrillation. There is increasing literature on the management of patients on coumadin who present with AIS, however there is a paucity of the same in reference to newer oral anticoagulants such as DE. We studied patients on DE who presented with AIS to better understand their clinical and laboratory characteristics. Methods: We retrospectively collected data on patients who had AIS and were on DE from 3 large stroke centers in California and Texas from December 2010 to August 2012. Data included baseline demographics, coagulation parameters, creatinine, GFR, use of IV rt-PA or intra-arterial thrombectomy (IAT), and duration of being off of DE prior to AIS. Descriptive statistics were used to evaluate the dataset. Results: Twenty-seven patients were identified, 16 (40.7%) were women, and the mean age was 70.6 (±13.7) years. Medication dosage was known for 17 patients:14 (82%) were taking 150 mg BID, 2 (11.8%) took 75 mg BID, and 1 (5.8%) took 75 mg daily. The median aPTT and INR were 37.1s (23.6s- >200s) and 1.1 (0.89-1.95) respectively. The median creatinine was 1.1 (0.7-1.6) and median GFR was 64ml/min/1.73m 2 (32-97). Sixteen (49.7%) of patients were actively taking DE prior to their acute event. One patient stopped it 48 hours, another 72 hours, and one 2 week prior to the AIS. Eleven (40.0%) of patients were concomitantly taking either aspirin or Plavix. Three were treated with IVtPA, two of which were taken for (IAT). None had hemorrhagic transformation. One patient had only IAT. Conclusions: To our knowledge this is the largest cohort of patients in the post-marketing phase of DE with acute ischemic strokes. The majority of the patients presented while actively taking DE, and more than half had normal INRs and aPTTs. As the use of DE and other novel oral anticoagulants increases, it will become imperative to create guidelines on how to manage these patients in the setting of AIS.