title: Revascularization for acute ischemic stroke is safe for rivaroxaban users.
abstract: BACKGROUND
  The safety of recombinant tissue plasminogen activator (rt-PA) and/or endovascular therapy for patients using the novel oral anticoagulant (NOAC) for atrial fibrillation remains unclear.
  
  
  METHODS
  We report a patient who was treated by both rt-PA and endovascular thrombectomy who suffered from acute ischemic stroke under treatment with NOAC.
  
  
  RESULTS
  An 83-year-old woman had a medical history with ischemic stroke due to paroxysmal atrial fibrillation and was then administered 10 mg of rivaroxaban daily. Although she took rivaroxaban in the morning, ischemic stroke recurred at midnight of that day. Soon after transferring to our hospital, we confirmed right middle cerebral artery (MCA) occlusion in the patient and then initiated treatment with intravenous rt-PA. Although no hemorrhagic complication occurred, recovery of her symptoms was not seen, and endovascular thrombectomy was performed. Although the inferior branch of the MCA was recanalized, an infarct was seen in her left frontal lobe. Hemorrhagic transformation was not observed during or after these combined treatments.
  
  
  CONCLUSIONS
  Thrombolysis and/or endovascular thrombectomy might be safe for patients treated with the new anticoagulant rivaroxaban.
authors.affiliation: Department of Neurology, Fukuoka University, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Department of Neurology, Fukuoka University, Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ogata
authors.affiliation: Department of Neurology, Fukuoka University, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Fukae
authors.affiliation: Department of Neurosurgery, Fukuoka University, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Okawa
authors.affiliation: Department of Neurosurgery, Fukuoka University, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Higashi
authors.affiliation: Department of Neurosurgery, Fukuoka University, Japan; Department of Emergency Medicine, Fukuoka University, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwaasa
authors.affiliation: Department of Neurosurgery, Fukuoka University, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Neurology, Fukuoka University, Japan. Electronic address: tsuboi@cis.fukuoka-u.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tsuboi
mesh_terms: D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000601:surgery* / Q000628:therapy; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D065427:Factor Xa Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications; D009025:Morpholines / Q000009:adverse effects* / Q000627:therapeutic use; D000069552:Rivaroxaban; D020521:Stroke / Q000601:surgery* / Q000628:therapy; D013876:Thiophenes / Q000009:adverse effects* / Q000627:therapeutic use; D017131:Thrombectomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban; D010959:Tissue Plasminogen Activator
keywords: Novel anticoagulant; revascularization; rt-PA; thrombectomy