• Jörg Berrouschot, Anett Stoll, Theresa Hogh, and Christoph Cyrill Eschenfelder.
• From the Department of Neurology, Klinikum Altenburger Land GmbH, Altenburg, Germany (J.B., A.S., T.H.); and Medical Affairs Germany, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany (C.C.E.). joerg.berrouschot@klinikum-altenburgerland.de.
• Stroke. 2016 Jul 1; 47 (7): 1936-8.

Background And PurposeTherapeutic options for acute ischemic stroke patients presenting on effective anticoagulation are limited. Idarucizumab, a humanized, monoclonal antibody fragment for immediate reversal of dabigatran, may allow this subgroup of orally anticoagulated patients to regain eligibility for thrombolysis.MethodsWe report the first successful acute antagonization of dabigatran by idarucizumab before intravenous thrombolysis with recombinant tissue-type plasminogen activator.ResultsIdarucizumab was given to a 76-year-old male patient on dabigatran ≈3.5 hours after his last dose. Neurological status on admission was NIHSS (National Institutes of Health Stroke Scale) 11. Recombinant tissue-type plasminogen activator was initiated immediately after dabigatran reversal. The patient was discharged with a favorable outcome of NHISS 1 on day 7. No complications were observed.ConclusionsThis case represents a new therapeutic paradigm. It is further supported by in vitro data showing no nonspecific interactions of idarucizumab with recombinant tissue-type plasminogen activator-induced thrombolysis. Thus, patients effectively anticoagulated with dabigatran who were previously contraindicated for thrombolytic therapy in this situation may now receive treatment because of the ability to rapidly reverse the anticoagulant activity of dabigatran with idarucizumab.© 2016 American Heart Association, Inc.

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