Intravenous alteplase and endovascular clot retrieval following reversal of dabigatran with idarucizumab

Introduction

Dabigatran etexilate (dabigatran) is a direct thrombin inhibitor that has been shown to prevent stroke in patients with atrial fibrillation. Idarucizumab is a humanised monoclonal antibody fragment developed to reverse the anticoagulant effects of dabigatran. Idarucizumab binds dabigatran 350 times more avidly than dabigatran binds thrombin, and completely reverses dabigatran’s biological activity within a few minutes.1 To date there have been only a handful of patients in whom dabigatran have been reversed with idarucizumab prior to treatment with intravenous alteplase, and none prior to endovascular clot retrieval.2 3

Methods

All New Zealand patients treated with alteplase must be entered into a national database, and this has noted whether idarucizumab was used prior to alteplase or clot retrieval since 2016. All patients treated with dabigatran and presenting within the 4.5-hour alteplase, or 6-hour endovascular clot retrieval treatment windows, had blood samples taken for thrombin clotting...

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