Background and Purpose- Reversal of dabigatran before intravenous thrombolysis in patients with acute ischemic stroke has been well described using alteplase but experience with intravenous tenecteplase is limited. Tenecteplase seems at least noninferior to alteplase in patients with intracranial large vessel occlusion. We report on the experience of dabigatran reversal before tenecteplase thrombolysis for acute ischemic stroke. Methods- We included consecutive patients with ischemic stroke receiving dabigatran prestroke treated with intravenous tenecteplase after receiving idarucizumab. Patients were from 2 centers in New Zealand and Australia. We reported the clinical, laboratory, and radiological characteristics and their functional outcome. Results- We identified 13 patients receiving intravenous tenecteplase after dabigatran reversal. Nine (69%) were male, median age was 79 (interquartile range, 69-85) and median baseline National Institutes of Health Stroke Scale score was 6 (interquartile range, 4-21). Atrial fibrillation was the indication for dabigatran therapy in all patients. All patients had a prolonged thrombin clotting time (median, 80 seconds [interquartile range, 57-113]). Seven patients with large vessel occlusion were referred for endovascular thrombectomy, 2 of these patients (29%) had early recanalization with tenecteplase abrogating thrombectomy. No patients had parenchymal hemorrhage or symptomatic hemorrhagic transformation. Favorable functional outcome (modified Rankin Scale score, 0-2) occurred in 8 (62%) patients. Two deaths occurred from large territory infarction. Conclusions- Our experience suggests intravenous thrombolysis with tenecteplase following dabigatran reversal using idarucizumab may be safe in selected patients with acute ischemic stroke. Further studies are required to more precisely estimate the efficacy and risk of clinically significant hemorrhage.

中文翻译：

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急性缺血性中风静脉使用替奈普酶之前的达比加群逆转。

背景和目的-使用阿替普酶已经很好地描述了急性缺血性卒中患者静脉溶栓前达比加群的逆转，但静脉使用替奈普酶的经验有限。在颅内大血管闭塞患者中，替奈普酶似乎至少不逊于阿替普酶。我们报道了替奈普酶溶栓治疗急性缺血性中风之前达比加群逆转的经验。方法-我们纳入了连续性缺血性中风患者，在接受伊达珠单抗后接受静脉注射替奈普酶治疗的达比加群中风。患者来自新西兰和澳大利亚的两个中心。我们报告了临床，实验室和放射学特征及其功能结果。结果-我们确定13例达比加群逆转后接受静脉内替奈普酶治疗的患者。男性（9％）（69％），中位年龄为79（四分位间距，69-85）和美国国立卫生研究院卒中量表基线中位数为6（四分位间距，4-21）。心房颤动是所有患者进行达比加群治疗的指征。所有患者的凝血酶凝血时间均延长（中位数为80秒[四分位间距57-113]）。7例大血管闭塞患者被推荐进行血管内血栓切除术，其中2例（29％）进行了替奈普酶消除血栓切除术的早期再通。没有患者发生实质性出血或症状性出血性转化。8例（62％）患者发生了良好的功能预后（改良的Rankin量表评分，0-2）。大面积梗死造成两人死亡。结论-我们的经验表明，使用依达珠单抗逆转达比加群逆转达比加群后的替奈普酶静脉溶栓治疗对部分急性缺血性卒中患者可能是安全的。需要进一步的研究以更精确地估计临床上大出血的疗效和风险。