TY - JOUR T1 - Intravenous alteplase and endovascular clot retrieval following reversal of dabigatran with idarucizumab JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp-2017-316449 SP - jnnp-2017-316449 AU - Dominic M Tse AU - Laura Young AU - Annemarei Ranta AU - P A Barber Y1 - 2017/10/06 UR - http://jnnp.bmj.com/content/early/2017/10/06/jnnp-2017-316449.abstract N2 - Dabigatran etexilate (dabigatran) is a direct thrombin inhibitor that has been shown to prevent stroke in patients with atrial fibrillation. Idarucizumab is a humanised monoclonal antibody fragment developed to reverse the anticoagulant effects of dabigatran. Idarucizumab binds dabigatran 350 times more avidly than dabigatran binds thrombin, and completely reverses dabigatran’s biological activity within a few minutes.1 To date there have been only a handful of patients in whom dabigatran have been reversed with idarucizumab prior to treatment with intravenous alteplase, and none prior to endovascular clot retrieval.2 3All New Zealand patients treated with alteplase must be entered into a national database, and this has noted whether idarucizumab was used prior to alteplase or clot retrieval since 2016. All patients treated with dabigatran and presenting within the 4.5-hour alteplase, or 6-hour endovascular clot retrieval treatment windows, had blood samples taken for thrombin clotting time (TCT) and activated partial thromboplastin time (APTT). Idarucizumab 5g was given intravenously if either the APTT or TCT was prolonged above the normal range for … ER -