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Republished: Successful thrombolysis for acute ischaemic stroke after reversal of dabigatran etexilate with idarucizumab
  1. Chee Hoou Loh,
  2. Geoffrey Herkes
  1. 1 Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Department of Neurology, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
  1. Correspondence to Dr Chee Hoou Loh, clemloh87{at}

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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.


We report the experience of reversing dabigatran prior to administering systemic thrombolysis for acute ischaemic cerebellar stroke, which was well tolerated with no haemorrhagic complications after thrombolysis. Given the increasingly common use of dabigatran for atrial fibrillation, the use of idarucizumab to reverse of dabigatran is a novel treatment that should be considered as an important adjunct to facilitate thrombolysis for ischaemic strokes and minimise haemorrhagic complications.


Cerebrovascular disease causes significant disease burden, becoming the second leading cause of mortality and the third leading cause of disability worldwide.1 Atrial fibrillation is a well-recognised cause of ischaemic stroke, affecting approximately 33 million people globally.2 Dabigatran is a direct oral anticoagulant (DOAC) that is now widely used for stroke prophylaxis in atrial fibrillation, thus management of DOAC becomes critical when stroke thrombolysis is being considered. Therapeutic anticoagulation with direct thrombin inhibitors or direct Xa inhibitors is a contraindication to stroke thrombolysis in major clinical guidelines,3 4 thus posing challenges to the use of potentially life-saving thrombolysis in acute ischaemic stroke. Idarucizumab is an effective agent for rapid reversal of the anticoagulant effect of dabigatran.5 6 Therefore, dabigatran reversal with idarucizumab is an uncommon but feasible management approach in minimising bleeding complications before administration of acute stroke thrombolysis.

Case presentation

We report a case of a 77-year-old man who presented to a local metropolitan hospital in Sydney, Australia, with left-sided weakness and speech difficulties.

This report is to highlight the novelty of reversing the anticoagulant activity of …

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  • Republished from Loh CH, Herkes G. Successful thrombolysis for acute ischaemic stroke after reversal of dabigatran etexilate with idarucizumab. BMJ Case Rep 2019;12:e229128. doi:10.1136/bcr-2018-229128

  • Contributors CHL contributed to writing up of the manuscript, in consultation with GH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Ethics approval Ethical approval has been sought from the Northern Sydney Local Health District Human Ethics Research Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.