Acute ischemic stroke treated with intravenous tissue plasminogen activator in a patient taking dabigatran with radiographic evidence of recanalization.
Dabigatran etexelate is a new oral direct thrombin inhibitor that has been approved by the US Food and Drug Administration to prevent stroke in patients with nonvalvular atrial fibrillation. A 51-year-old man with a history of atrial fibrillation who was taking dabigatran presented with an acute ischemic stroke. The patient had a normal international normalized ratio, activated partial thromboplastin time, and an elevated thrombin time of 26.4 seconds. Recanalization of the middle cerebral artery with intravenous tissue plasminogen activator was apparent on digital subtraction angiography, and there was no evidence of intracerebral hemorrhage on the repeat computed tomographic scan. This is the first report of a patient who was taking dabigatran etexilate and who had an ischemic stroke caused by a middle cerebral artery occlusion, with an elevated thrombin time and radiographic recanalization with intravenous tissue plasminogen activator without evidence of hemorrhagic transformation.
Department of Neurology, University of Texas Medical School at Houston, Houston, Texas 77030, USA. navdeep.s.sangha@uth.tmc.edu
Navdeep
N
Sangha
Ramy
R
El Khoury
Vivek
V
Misra
George
G
Lopez
D015901:Angiography, Digital Subtraction; D000991:Antithrombins / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001562:Benzimidazoles / Q000627:therapeutic use*; D002533:Cerebral Angiography / Q000379:methods; D000069604:Dabigatran; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D055420:Perfusion Imaging / Q000379:methods; D013918:Thrombin Time; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000991:Antithrombins; D001562:Benzimidazoles; D005343:Fibrinolytic Agents; D015091:beta-Alanine; D010959:Tissue Plasminogen Activator; D000069604:Dabigatran