title: Intravenous thrombolysis for acute ischemic stroke in a patient receiving rivaroxaban.
abstract: BACKGROUND
  Rivaroxaban is an oral direct factor Xa inhibitor increasingly used in stroke prevention in nonvascular atrial fibrillation, primary prevention and treatment of venous thromboembolism, and secondary prevention in acute coronary syndromes.
  
  
  METHODS
  Thrombolytic treatment has established efficacy in acute ischemic stroke.
  
  
  RESULTS
  We report the case of a 76-year-old female under rivaroxaban for paroxysmal nonvalvular atrial fibrillation who presented an acute ischemic stroke. The brain magnetic resonance imaging diffusion-weighted sequences showed increased signal in the territory of the left middle cerebral artery. Platelet count was normal. PT was 55% (normal, 70-120); the international normalized ratio was 1.51 (normal, .90-1.40). She underwent intravenous thrombolysis 210 minutes after stroke onset without bleeding complication and with complete clinical recovery.
  
  
  CONCLUSIONS
  This case underlines the need for further studies on the safety of thrombolysis in stroke patients taking rivaroxaban. Our case emphasizes the urgent need for sensitive coagulation bed-side tests during stroke emergencies.
authors.affiliation: Neurology Department, University Hospital of Pointe-à-Pitre, Route de Chauvel, Abymes Guadeloupe, France. Electronic address: landais-anne@voila.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Landais
authors.affiliation: Emergency Unit, University Hospital of Pointe-à-Pitre, Route de Chauvel, Abymes Guadeloupe, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ginoux
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy*; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D038524:Diffusion Magnetic Resonance Imaging; D004347:Drug Interactions; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D019934:International Normalized Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D000069552:Rivaroxaban
keywords: Acute stroke; new direct oral anticoagulant; rivaroxaban; thrombolysis