Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany-Updated series of 120 cases

被引：67

作者：

Kermer, Pawel ^{[1
,2
]}

Eschenfelder, Christoph C. ^{[3
]}

Diener, Hans-Christoph ^{[4
]}

Grond, Martin ^{[5
]}

Abdalla, Yasser ^{[6
]}

Abraham, Alexej ^{[7
]}

Althaus, Katharina ^{[8
]}

Becks, Gebhard ^{[9
]}

Berrouschot, Joerg ^{[10
]}

Berthel, Joerg ^{[11
]}

Bode, Felix J. ^{[12
,13
]}

Burghaus, Lothar ^{[14
]}

Canguer, Hakan ^{[15
]}

Daffertshofer, Michael ^{[16
]}

Edelbusch, Sebastian ^{[17
]}

Eggers, Juergen ^{[18
]}

Gerlach, Ruediger ^{[19
]}

Groeschel, Klaus ^{[20
]}

Grosse-Dresselhaus, Florian ^{[17
]}

Guenther, Albrecht ^{[21
]}

Haase, Claus G. ^{[22
]}

Haensch, Carl-Albrecht ^{[23
]}

Harloff, Andreas ^{[24
]}

Heckmann, Joseph G. ^{[25
]}

Held, Valentin ^{[26
]}

Hieber, Maren ^{[24
]}

Kauert, Andreas ^{[7
]}

Kern, Rolf ^{[27
]}

Kerz, Thomas ^{[28
]}

Koehrmann, Martin ^{[4
]}

Kraft, Peter ^{[29
,30
]}

Kuehnlein, Peter ^{[31
]}

Latta, Jan ^{[32
]}

Leinisch, Elke ^{[33
]}

Lenz, Arne ^{[34
]}

Leithner, Christoph ^{[35
]}

Neumann-Haefelin, Tobias ^{[11
]}

Maeurer, Mathias ^{[36
]}

Muellges, Wolfgang ^{[30
]}

Nolte, Christian H. ^{[37
]}

Obermann, Mark ^{[38
]}

Partowi, Someieh ^{[39
]}

Patzschke, Peer ^{[40
]}

Poli, Sven ^{[41
,42
]}

Pulkowski, Ulrich ^{[43
]}

Purrucker, Jan ^{[44
]}

Rehfeldt, Torsten ^{[45
]}

Ringleb, Peter A. ^{[44
]}

Roether, Joachim ^{[46
]}

Rossi, Raluca ^{[47
]}

机构：

[1] Nordwestkrankenhaus Sanderbusch, Dept Neurol, Gut Sanderbusch 1, D-26452 Sande, Germany

[2] Univ Med Gottingen, Dept Neurol, Gottingen, Germany

[3] Boehringer Ingelheim Pharma GmbH & Co KG, Med Affairs Germany, Ingelheim, Germany

[4] Univ Hosp, Dept Neurol, Essen, Germany

[5] Dept Neurol, Siegen, Germany

[6] Nordwestkrankenhaus Sanderbusch, Dept Neurosurg, Sande, Germany

[7] Evangel Krankenhaus Konigin Elisabeth Herzberge, Dept Neurol, Berlin, Germany

[8] Univ Ulm, Dept Neurol, Ulm, Germany

[9] Klinikum Itzehoe, Dept Neurol, Itzehoe, Germany

[10] Klinikum Altenburger Land GmbH, Dept Neurol, Altenburg, Germany

[11] Klinikum Fulda, Dept Neurol, Fulda, Germany

[12] Univ Bonn, Dept Neurol, Bonn, Germany

[13] German Ctr Neurodegenerat Dis, Dept Neurol, Bonn, Germany

[14] Heilig Geist Krankenhaus, Dept Neurol, Cologne, Germany

[15] Klinikum Wolfsburg, Dept Neurol, Wolfsburg, Germany

[16] Klinikum Mittelbaden, Dept Neurol, Rastatt, Germany

[17] Herz Jesu Krankenhaus Hiltrup, Dept Neurol, Munster, Germany

[18] Sana Kliniken Lubeck, Dept Neurol, Lubeck, Germany

[19] Helios Klinikum Erfurt, Dept Neurosurg, Erfurt, Germany

[20] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Neurol, Mainz, Germany

[21] Univ Jena, Dept Neurol, Jena, Germany

[22] Evangel Kliniken Gelsenkirchen, Dept Neurol & Clin Neurophysiol, Gelsenkirchen, Germany

[23] Kliniken Maria Hilf, Dept Neurol, Mochengladbach, Germany

[24] Univ Freiburg, Fac Med, Med Ctr Univ Freiburg, Dept Neurol & Neurophysiol, Freiburg, Germany

[25] Klinikum Landshut, Dept Neurol, Landshut, Germany

[26] Univ Med Mannheim, Dept Neurol, Mannheim, Germany

[27] Klin Verbund Kempten Oberallgau, Dept Neurol, Kempten, Germany

[28] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Neurosurg, Mainz, Germany

[29] Klinikum Main Spessart, Dept Neurol, Lohr, Germany

[30] Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany

[31] Regiomed Kliniken, Dept Neurol, Coburg, Germany

[32] Helios Klin, Dept Neurol, Hildburghausen, Germany

[33] HELIOS Klin, Dept Neurol, Erfurt, Germany

[34] Sozialstiftung Bamberg, Dept Neurol, Bamberg, Germany

[35] Charite, Campus Virchow Klinikum, Dept Neurol, Berlin, Germany

[36] Klinikum Wurzburg Mitte, Dept Neurol, Wurzburg, Germany

[37] Charite, Campus Benjamin Franklin, Dept Neurol, Berlin, Germany

[38] Asklepios Hosp Schildautal, Ctr Neurol, Seesen, Germany

[39] Marienhaus Klinikum, Stroke Unit, Kreis Ahrweiler, Bad Neuenahr Ah, Germany

[40] Westkustenkliniken, Brunsbuttel, Germany

[41] Univ Hosp Tubingen, Dept Neurol Focus Neurovasc Dis & Neurooncol, Tubingen, Germany

[42] Univ Hosp Tubingen, Hertie Inst Clin Brain Res, Tubingen, Germany

[43] Imland Klin, Dept Neurol, Rendsburg, Germany

[44] Univ Hosp Heidelberg, Dept Neurol, Heidelberg, Germany

[45] Dietrich Bonhoeffer Klinikum, Dept Neurol, Neubrandenburg, Germany

[46] Asklepios Klin Altona, Dept Neurol, Hamburg, Germany

[47] Main Kinzig Kliniken, Dept Neurol, Gelnhausen, Germany

[48] Klinikum Lippe, Dept Neurol, Lemgo, Germany

[49] Diakonie Klinikum, Dept Neurol, Schwabisch Hall, Germany

[50] Univ Hosp Dresden, Dept Neurosurg, Dresden, Germany

来源：

INTERNATIONAL JOURNAL OF STROKE | 2020年 / 15卷 / 06期

关键词：

Idarucizumab; dabigatran; ischemic stroke; thrombolysis; intracranial hemorrhage; outcome; VITAMIN-K ANTAGONIST; INTRACEREBRAL HEMORRHAGE; ORAL ANTICOAGULANTS; INTRAVENOUS THROMBOLYSIS; ATRIAL-FIBRILLATION; SYSTEMIC THROMBOLYSIS; WARFARIN; REVERSAL; ALTEPLASE; METAANALYSIS;

D O I：

10.1177/1747493019895654

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage. Methods Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used. Results One-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0-3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay. Conclusion Administration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.

引用

页码：609 / 618

页数：10

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