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The following is a summary of “Thrombolysis After Dabigatran Reversal for Acute Ischemic Stroke: A National Registry-Based Study and Meta-Analysis,” published in the September 2024 issue of Neurology by Theodorou et al.
The safety of IV thrombolysis (IVT) for acute ischemic stroke (AIS) after dabigatran reversal with idarucizumab remains uncertain due to limited data.
Researchers conducted a retrospective study evaluating the safety and efficacy of idarucizumab pretreatment in patients with AIS receiving IVT.
They evaluated IVT’s safety and efficacy in patients with AIS from a national registry-based cohort. A meta-analysis of cohort studies and case series was conducted to assess pooled rates of symptomatic intracranial hemorrhage (sICH), any ICH, 3-month mortality, excellent (modified Rankin Scale [mRS] 0–1), and finally, good (mRS 0–2) 3-month functional outcomes in patients with AIS who received IVT after dabigatran reversal with idarucizumab. Outcomes were compared between patients treated with IVT following dabigatran reversal and those without dabigatran exposure.
The results showed 553 patients with AIS (mean age: 75 years; 65% male; median NIH Stroke Scale score: 11) who received idarucizumab before IVT. The pooled rate of sICH after IVT was 4% (95% CI 1–9; I2 = 26%), while any ICH occurred at 10% (95% CI 5–16; I2 = 24%), and 3-month mortality was 18% (95% CI 10–27; I2 = 0%). Excellent and good 3-month functional outcomes were 56% (95% CI 27–83; I2 = 69%) and 70% (95% CI 57–81; I2 = 40%). No significant differences were found in the risk of sICH (RR 1.86; 95% CI 0.91–3.80; I2 = 0%), any ICH (RR 1.76; 95% CI 0.99–3.11; I2 = 8%), or 3-month mortality (RR 1.50; 95% CI 0.91–2.48; I2 = 0%) between patients receiving IVT with and without idarucizumab. Idarucizumab administration was linked to a higher likelihood of achieving a good functional outcome at 3 months (RR 1.35; 95% CI 1.11–1.65; I2 = 27%).
Investigators concluded that IVT for AIS after dabigatran reversal with idarucizumab appeared to be safe and effective, but RCTs were needed to confirm the findings.
Source: neurology.org/doi/10.1212/WNL.0000000000209862
