Fibrinolytic treatment of acute ischemic stroke for patients on new oral anticoagulant drugs

摘要

In this issue, Naranjo et al. report on a patient who was off-label treated with dabigatran 110 mg twice daily after electric car-dioversion and developed a large middle cerebral artery (MCA) ischemic stroke after having taken the third dose of dabigatran. Prior to cardioversion, the patient received enoxaparin at an unknown dose for 1 month. No transesophageal echocardiography for exclusion of intracardial thrombi was performed. Thrombolysis with rtPA was initiated 190 min after onset of symptoms corresponding to approximately 6 h after the last dose of dabigatran, and the patient developed fatal intracerebral hemorrhage 12 h later.