• Fredrik von Wowern, Marco Brizzi, and Jan Holst.
• Department of Internal Medicine, University Hospitals of Skåne - Malmö, Skane, Sweden.
• Eur J Case Rep Intern Med. 2017 Jan 1; 4 (4): 000569.

ObjectiveTo describe the benefits of reversal of the anticoagulation effects of dabigatran etexilate in patients requiring urgent surgery or thrombolysis for ischaemic stroke.Materials And MethodsFour patients, treated with dabigatran etexilate and presenting with cholecystitis, tibial fracture, lower limb ischaemia and ischaemic stroke, respectively.ResultsAdministration of idarucizumab normalized bleeding parameters and provided safe conditions for surgery and, in one case, successful thrombolysis of an ischaemic stroke.ConclusionThe introduction of an effective reversal agent for dabigatran etexilate allows physicians perform surgery under conditions of normal coagulation and permits thrombolysis in patients with ischaemic stroke despite being treated with dabigatran etexilate.Learning PointsNovel oral anticoagulants (NOACs) are a safe alternative to warfarin to prevent ischaemic stroke.Ability to reverse the anticoagulant effects of NOACs could increase adherence to anticoagulation therapy, thereby decreasing the risk of ischaemic stroke.Reversal of the anticoagulant effect of dabigatran etexilate can improve the outcome in patients needing urgent surgery, intervention and thrombolysis.

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