Summary

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.

Background

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 …