Dabigatran and acute stroke thrombolysis.

摘要

We recently treated a 75-year-old woman who presented 33 min into a left middle cerebral artery territory ischemic stroke with a National Institute of Health Stroke Scale (NIHSS) score of 8. She was a recent participant in the RE-LY study comparing warfarin to dabigatran for stroke prevention in atrial fibrillation [1] and was normally now on dabigatran. Three days prior to her event, she had discontinued dabigatran in preparation for excision of a nasal basal cell carcinoma. She had resumed the drug 2.5 h prior to the event. Because of the pharmacokinetic properties of dabigatran, we elected not to thrombolyse the patient. Twenty-four hours after the event, her NIHSS score was 2.Dabigatran is a direct thrombin inhibitor with a reported half-life of 11 h in healthy volunteers and reaches peak plasma concentration in 30 min to 2 h [2]. At a dose of 150 mg twice daily, it has similar rates of major hemorrhage as warfarin targeted to an international normalized ratio (INR) of 2.0-3.0 [1, 3]. Current use of an oral anticoagulant or having an INR of >1.7 are considered contraindications to thrombolytic therapy in acute stroke [4].