Application of Dabigatran antidote in iv – tpa patients with acute ischemic stroke – clinical experience

Abstract

Acute ischemic stroke (AIS) and the permanent disability resulting from it have serious social consequences for our society. The need for increasing the efforts made by GPs, cardiologists and neurologists in Bulgaria regarding the primary and secondary prevention of stroke is increasing. For the second year, we have seen a steady improvement in the data on specific therapy for AIS in our country, but the results are still far from those currently recommended by leading international stroke organizations such as the ESO. Direct oral anticoagulants have been widely used for the secondary prevention of ischemic stroke in patients with AF, but they are contraindications for intravenous thrombolysis in cases with regular administration. This makes endovascular treatment the only chance for spesific therapy in these patients, but unfortunately in Bulgaria there are still only 4 hospitals that can realize it. The basic requirement for this to occur within 6 hours of the onset of symptoms of AIS makes the procedure inapplicable in many of these cases. Therefore, the presence of a specific antidote (Idarucizumab) for one of the DOAC (Dabigatran) on the one hand makes it possible to carry out intravenous thrombolysis in these patients, and on the other gives the advantage of Dabigatran when choosing a DOAC for cases of AF and AIS. The results of the literature in these cases, as well as those of our practice in our clinic, show a comparable efficacy and frequency of complications to the general group of patients with intravenous thrombolysis, which provides a recommendation for adherence to this therapeutic approach.