• Derya Tireli, Jun He, Mette Maria Nordling, and Troels Wienecke.
• Neurovascular Center, Department of Neurology, Zealand University Hospital, Roskilde, Denmark. Electronic address: deti@regionsjaelland.dk.
• J Stroke Cerebrovasc Dis. 2017 Jul 1; 26 (7): e123-e125.

IntroductionIdarucizumab is a reversal agent for dabigatran etexilate. By reversing the anticoagulating effect of dabigatran etexilate with idarucizumab (Praxbind), patients presenting with an acute ischemic stroke can now be eligible for thrombolysis.PatientWe describe our experience with idarucizumab in a 71-year-old male patient pretreated with dabigatran etexilate. The patient arrived with a hemiparesis, central facial palsy, and dysarthria.MethodDabigatran etexilate was antagonized with idarucizumab, approximately 2.5 hours after the patient's last dose. Immediately after the infusion of idarucizumab, the patient received thrombolytic therapy.ResultsThe hemiparesis and the central facial palsy were fully remitted 3 days after the onset of symptoms, and the dysarthria was remitted 2 days afterwards.DiscussionNon-vitamin K oral anticoagulants (NOACs) are widely used for the prevention of embolic stroke in patients with atrial fibrillation. Dabigatran etexilate is an oral thrombin inhibitor that can be reversed by idarucizumab. Idarucizumab, a monoclonal antibody fragment, directly binds dabigatran etexilate and neutralizes its activity.ConclusionReversal of dabigatran etexilate using idarucizumab was safe and successful with no recombinant tissue plasminogen activator interactions.Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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