Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany-Updated series of 120 cases.

Abstract

BACKGROUND:

Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth.

AIMS:

To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage.

METHODS:

Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used.

RESULTS:

One-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0-3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay.

CONCLUSION:

Administration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.

• Authors: Pawel Kermer, Christoph C Eschenfelder, Hans-Christoph Diener, Martin Grond, Yasser Abdalla, Alexej Abraham, Katharina Althaus, Gebhard Becks, Jörg Berrouschot, Jörg Berthel, Felix J Bode, Lothar Burghaus, Hakan Cangür, Michael Daffertshofer, Sebastian Edelbusch, Jürgen Eggers, Rüdiger Gerlach, Klaus Gröschel, Florian Große-Dresselhaus, Albrecht Günther, Claus G Haase, Carl-Albrecht Haensch, Andreas Harloff, Joseph G Heckmann, Valentin Held, Maren Hieber, Andreas Kauert, Rolf Kern, Thomas Kerz, Martin Köhrmann, Peter Kraft, Peter Kühnlein, Jan Latta, Elke Leinisch, Arne Lenz, Christoph Leithner, Tobias Neumann-Haefelin, Mathias Mäurer, Wolfgang Müllges, Christian H Nolte, Mark Obermann, Someieh Partowi, Peer Patzschke, Sven Poli, Ulrich Pulkowski, Jan Purrucker, Torsten Rehfeldt, Peter A Ringleb, Joachim Röther, Raluca Rossi, Hazem El-Sabassy, Oliver Sauer, Gabriele Schackert, Niklas Schäfer, Peter D Schellinger, Andreas Schneider, Ramona Schuppner, Stefan Schwab, Olav Schwarte, Rüdiger J Seitz, Sebastian Senger, Yogesh P Shah, Eckhart Sindern, Paul Sparenberg, Thorsten Steiner, Kristina Szabo, Christian Urbanek, Bettina von Sarnowksi, Karin Weissenborn, Peter Wienecke, Karsten Witt, Robert Wruck, Silke Wunderlich
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 15 Issue 6 Pg. 609-618 (08 2020) ISSN: 1747-4949 [Electronic] United States
• PMID: 31955706 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antithrombins
• idarucizumab
• Dabigatran

Topics

• Antibodies, Monoclonal, Humanized
• Antithrombins (therapeutic use)
• Brain Ischemia (complications, drug therapy)
• Dabigatran (therapeutic use)
• Germany
• Humans
• Intracranial Hemorrhages (drug therapy)
• Ischemic Stroke
• Retrospective Studies
• Stroke (drug therapy)
• Thrombolytic Therapy