Journal of Thrombosis and Thrombolysis

, Volume 43, Issue 4, pp 528–529 | Cite as

Intravenous thrombolysis for stroke after Dabigatran reversal with Idarucizumab: an update

  • Manuel CappellariEmail author
  • Stefano Forlivesi
  • Giovanna Maddalena Squintani
  • Roberto Facchinetti
  • Paolo Bovi
Letter to the Editor

Dear Editor,

Safety of intravenous thrombolysis (IVT) for ischemic stroke in patients under direct oral anticoagulant (DOAC) treatment is an even dilemma. Until there are no established cut-off values for specific tests that are able to alert clinicians to bleeding risk of IV recombinant tissue plasminogen activator (rt-PA), IVT is discouraged in stroke patients receiving DOAC <24–48 h [1]. Mechanical recanalization may be considered as an alternative treatment option for stroke related to large vessel occlusion [2]. Although half-life of DOAC is short, the rapid antagonization of the anticoagulant effect before IVT may be a new strategy. Among all DOACs, only Dabigatran currently has a specific and approved antidote for use during emergency situations when there is a need to reverse the anticoagulant effects. Idarucizumab is a humanized monoclonal antibody fragment that binds Dabigatran and irreversibly neutralizes the anticoagulant effect; the effect of Idarucizumab is extremely...


Stroke Patient Dabigatran Alteplase Anticoagulant Effect Intravenous Thrombolysis 
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Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11239_2017_1485_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 KB)


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    Purrucker JC, Wolf M, Haas K et al (2016) Safety of endovascular thrombectomy in patients receiving non-vitamin K antagonist oral anticoagulants. Stroke 47:1127–1130CrossRefPubMedGoogle Scholar
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    Eikelboom JW, Quinlan DJ, van Ryn J et al (2015) Idarucizumab: the antidote for reversal of Dabigatran. Circulation 132:2412–2422CrossRefPubMedGoogle Scholar
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    Cappellari M, Bovi P (2015) Intravenous thrombolysis for stroke in patients taking non-VKA oral anticoagulants: an update. Thromb Haemost 114:440–444CrossRefPubMedGoogle Scholar
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    Pollack CV Jr, Reilly PA, Eikelboom J et al (2015) Idarucizumab for Dabigatran reversal. N Engl J Med 373:511–520CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Manuel Cappellari
    • 1
    Email author
  • Stefano Forlivesi
    • 1
  • Giovanna Maddalena Squintani
    • 1
  • Roberto Facchinetti
    • 2
  • Paolo Bovi
    • 1
  1. 1.USD Stroke Unit, DAI di NeuroscienzeAzienda Ospedaliera Universitaria IntegrataVeronaItaly
  2. 2.Laboratorio Analisi, DAI Patologia e DiagnosticaAzienda Ospedaliera Universitaria IntegrataVeronaItaly

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