BACKGROUND Idarucizumab is a specific antidote for the anticoagulant dabigatran. Although its efficacy has been recently reported, the drug is still in postmarketing surveillance and requires case data in different emergency settings. A newer intravenous thrombolytic therapy with recombinant tissue plasminogen activator has been proposed after injection of idarucizumab in patients receiving dabigatran; however, the safety and efficacy of this therapy are equivocal because of the limited number of reported cases. We describe a case of a patient with acute lacunar stroke causing dysarthria and hemiparesis successfully treated with intravenous thrombolytic therapy with recombinant tissue plasminogen activator after reversal of dabigatran with idarucizumab. CASE PRESENTATION A 67-year-old Asian woman was transferred to our emergency center 200 minutes after sudden onset of dysarthria and right-sided hemiparesis. She had been taking dabigatran for prevention of stroke recurrence caused by atrial fibrillation. Diffusion-weighted magnetic resonance imaging revealed a new lacunar infarction near old putamen infarctions. We treated her with intravenous thrombolytic therapy with recombinant tissue plasminogen activator after administering idarucizumab. The time to recombinant tissue plasminogen activator administration was 5 minutes from idarucizumab injection and 269 minutes from symptom onset. The patient's activated partial thromboplastin times were 68.0 and 43.2 seconds before and after the therapy, respectively. The patient's neurological symptoms improved significantly after the treatment, and she experienced no adverse events. CONCLUSIONS Intravenous thrombolytic therapy with recombinant tissue plasminogen activator after reversal of dabigatran with idarucizumab may be safe and feasible in patients with acute ischemic stroke with lacunar infarct. Furthermore, intravenous thrombolytic therapy with recombinant tissue plasminogen activator could be used in patients in emergency settings until just before the end of the recommended time limit within which it needs to be administered because of the immediate effect of idarucizumab.

中文翻译：

---

依达珠单抗逆转达比加群后，在缺血性卒中中使用重组组织纤溶酶原激活剂成功溶栓治疗：一例病例报告。

背景技术伊达珠单抗是抗凝剂达比加群的特异性解毒剂。尽管最近已经报道了其功效，但该药物仍处于上市后监控中，并且需要不同紧急情况下的病例数据。在接受达比加群治疗的患者中注射伊达珠单抗后，已提出了一种采用重组组织纤溶酶原激活剂的新型静脉溶栓治疗方法。然而，由于报道的病例数量有限，这种疗法的安全性和有效性是模棱两可的。我们描述了一例急性腔隙性中风导致构音障碍和偏瘫的患者，在达比加群与依达珠单抗逆转后，成功用重组组织纤溶酶原激活剂静脉溶栓治疗。病例介绍构音障碍突然发作和右侧偏瘫后200分钟，一名67岁的亚洲妇女被转移到我们的急诊中心。她一直在服用达比加群，以预防由心房纤颤引起的中风复发。扩散加权磁共振成像显示在旧壳核梗死附近有新的腔隙性梗塞。服用伊达珠单抗后，我们用重组组织纤溶酶原激活剂对她进行了静脉溶栓治疗。注射重组组织纤溶酶原激活剂的时间为伊达珠单抗注射后5分钟，症状发作后269分钟。在治疗之前和之后，患者的活化部分凝血活酶时间分别为68.0和43.2秒。治疗后患者的神经系统症状明显改善，她没有发生任何不良事件。结论达比加群逆转伊达单抗后，重组组织纤溶酶原激活剂静脉溶栓治疗在腔隙性梗塞急性缺血性卒中患者中是安全可行的。此外，在紧急情况下，由于伊达珠单抗的即时作用，可以在紧急情况下的患者中使用重组组织纤溶酶原激活剂进行静脉溶栓治疗，直至即将到来的推荐使用期限之前。