Clinical experience with idarucizumab prior to thrombolytic therapy of cerebral infarction in the Sverdlovsk region

Abstract

Introduction. In recent years, the use of oral anticoagulants for the prevention of ischemic strokes (IS) in patients with atrial fibrillation (AF), as well as the prevention of deep vein thrombosis and thromboembolism has been increasing in clinical practice. According to epidemiological studies, ischemic strokes account for about 85% of all AMI. Cardioembolic strokes (CES), which develop due to embolism to the cerebral vessels from the heart chambers, deserve special attention. The presence of AF is associated with a twofold increase in the risk of death from cardiovascular disease and death from any cause. Timely anticoagulant therapy can reduce the risk of thromboembolic complications and improve the prognosis. Materials and Methods. The authors present a clinical observation in which a 47-year-old female patient diagnosed with venous insufficiency, who took dabigatran 150 mg twice a day for a year, developed IS with left-sided pronounced hemiparesis. After 170 minutes from the development of the stroke, idarucizumab was administered to neutralize the anticoagulant effect of dabigatran and thrombolytic therapy (TLT) was performed. Results. Twenty-four hours after TLT, the National Institutes of Health Stroke Scale (NIHSS) score decreased from 16 to 6. A repeat CT scan of the brain revealed a focus of ischemia in the right frontal, parietal, and temporal lobes. On the 19th day of the AI, dabigatran 150 mg 2 times a day was resumed. Conclusion. The presented observation confirms that in patients with AI developed against the background of dabigatran, the administration of idarucizumab is safe and allows for TLT.