Treatment with idarucizumab can safely facilitate stroke thrombolysis in dabigatran-treated patients, with similar outcomes as patients who did not require idarucizumab therapy, according to study results published in Neurology.

Several case reports have described the outcomes of stroke thrombolysis following reversal of the anticoagulant effect of dabigatran with idarucizumab. The goal of the current observational cohort study was to assess the outcomes of idarucizumab treatment prior to intravenous thrombolysis. The study compared a national cohort that included all New Zealand patients with stroke treated with reperfusion with patients who did not receive treatment with idarucizumab.

Included in the study were 1336 participants treated with thrombolysis between January 2017 and December 2018. Of these, 51 patients (mean age 73.3 years) were treated with idarucizumab prior to thrombolysis. During the 24-month period, 386 patients were treated with thrombectomy, including 8 treated with idarucizumab.

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Due to the additional time needed to determine the date of the last dabigatran dose, the results of coagulation tests, and the time required to administer idarucizumab, use of idarucizumab resulted in >20 minutes of delays in the door-to-CT, door-to-needle (83 vs 61 minutes, P =.0006), and onset-to-needle time (163 vs 145.5 minutes, P =.046) in patients compared to those who did not receive idarucizumab.

There were no differences in the change of the National Institute of Health Stroke Scale (NIHSS) score from baseline to 24 hours in idarucizumab-treated patients compared to patients who did not receive idarucizumab. Idarucizumab-treated patients had similar early neurologic improvement and 7-day mortality, the same rate of symptomatic intracranial hemorrhage, and no significant early thrombotic complications. At 7 days, 3 (5.9%) idarucizumab-treated and 101 (7.9%) of the additional thrombolyzed patients had died (P =.61).

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The researchers acknowledged several study limitations, including the observational design, missing data on the timing of idarucizumab initiation or the results of coagulation tests, and the fact that data were recorded only up to 7 days after stroke onset.

“Idarucizumab appeared to be safe with similar clinical outcomes to routinely managed patients, despite a 22-minute door-to-needle time delay,” concluded the researchers.


Barber PA, Wu TY, Ranta A. Stroke reperfusion therapy following dabigatran reversal with idarucizumab in a national cohort [published online ahead of print, February 20, 2020]. Neurology. doi: 10.1212/WNL.0000000000009155