Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany - A national case collection

被引：63

作者：

Kermer, Pawel ^{[1
]}

Eschenfelder, Christoph C. ^{[2
]}

Diener, Hans-Christoph ^{[3
]}

Grond, Martin ^{[4
]}

Abdalla, Yasser ^{[5
]}

Althaus, Katharina ^{[6
]}

Berrouschot, Joerg ^{[7
]}

Canguer, Hakan ^{[8
]}

Daffertshofer, Michael ^{[9
]}

Edelbusch, Sebastian ^{[10
]}

Groeschel, Klaus ^{[11
]}

Haase, Claus G. ^{[12
]}

Harloff, Andreas ^{[13
]}

Held, Valentin ^{[14
]}

Kauert, Andreas ^{[15
]}

Kraft, Peter ^{[16
]}

Lenz, Arne ^{[17
]}

Muellges, Wolfgang ^{[16
]}

Obermann, Mark ^{[18
]}

Partowi, Someieh ^{[19
]}

Purrucker, Jan ^{[20
]}

Ringleb, Peter A. ^{[20
]}

Roether, Joachim ^{[21
]}

Rossi, Raluca ^{[22
]}

Schaefer, Niklas ^{[23
]}

Schneider, Andreas ^{[12
]}

Schuppner, Ramona ^{[24
]}

Seitz, Ruediger J. ^{[25
]}

Szabo, Kristina ^{[14
]}

Wruck, Robert ^{[9
]}

机构：

[1] Nordwestkrankenhaus Sanderbusch, Dept Neurol, Sande, Germany

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

[3] Univ Hosp, Dept Neurol, Hufelandstr 55, D-45147 Essen, Germany

[4] Kreiskrankenhaus Siegen, Dept Neurol, Siegen, Germany

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

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

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

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

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

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

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

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

[13] Univ Med Ctr, Dept Neurol, Freiburg, Germany

[14] Univ Hosp Mannheim, Dept Neurol, Mannheim, Germany

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

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

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

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

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

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

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

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

[23] Univ Bonn, Dept Neurol, Med Ctr, Bonn, Germany

[24] Hannover Med Sch, Dept Neurol, Hannover, Germany

[25] Landschaftsverband Rheinland Klinikum Dusseldorf, Dept Neurol, Ctr Neurol & Neuropsychiat, Dusseldorf, Germany

来源：

INTERNATIONAL JOURNAL OF STROKE | 2017年 / 12卷 / 04期

关键词：

Idarucizumab; dabigatran; ischemic stroke; intracranial hemorrhage; thrombolysis; outcome; ATRIAL-FIBRILLATION; INTRAVENOUS THROMBOLYSIS; SYSTEMIC THROMBOLYSIS; WARFARIN; REVERSAL; ANTICOAGULANTS; EFFICACY; EVENTS; SAFETY;

D O I：

10.1177/1747493017701944

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 that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage. Methods Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January to August 2016 were used. Results Thirty-one patients presenting with signs of stroke received idarucizumab in 22 stroke centers. Nineteen patients treated with dabigatran presented with ischemic stroke and 12 patients suffered from intracranial bleeding. In patients receiving rt-PA thrombolysis following idarucizumab, 79% benefitted from i.v. thrombolysis with a median improvement of five points in NIHSS. No bleeding complications occurred. Hematoma growth was observed in 2 out of 12 patients with intracranial hemorrhage. The outcome was favorable with a median NIHSS improvement of 5.5 points and mRS 0-3 in 67%. Overall, mortality was low with 6.5% (one patient in each group). Conclusion Administration of rt-PA after reversing dabigatran activity with idarucizumab in case of ischemic stroke is feasible, easy to manage, effective, and appears to be safe. In dabigatran-associated intracranial hemorrhage, idarucizumab has the potential to prevent hematoma growth and improve outcome. Idarucizumab represents a new therapeutic option for patients under dabigatran treatment presenting with ischemic stroke or intracranial hemorrhage.

引用

页码：383 / 391

页数：9

共 23 条

[1]

[Anonymous], 2016, EUR HEART J

[2]

Bernstein RA, 2016, STROKE, V47, pA213

[3] Intravenous Thrombolysis With Recombinant Tissue-Type Plasminogen Activator in a Stroke Patient Receiving Dabigatran Anticoagulant After Antagonization With Idarucizumab [J].

Berrouschot, Joerg ;

Stoll, Anett ;

Hogh, Theresa ;

Eschenfelder, Christoph Cyrill .

STROKE, 2016, 47 (07) :1936-1938

[4] Additional Events in the RE-LY Trial [J].

Connolly, Stuart J. ;

Wallentin, Lars ;

Yusuf, Salim .

NEW ENGLAND JOURNAL OF MEDICINE, 2014, 371 (15) :1464-1465

[5] Newly Identified Events in the RE-LY Trial [J].

Connolly, Stuart J. ;

Ezekowitz, Michael D. ;

Yusuf, Salim ;

Reilly, Paul A. ;

Wallentin, Lars .

NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (19) :1875-1876

[6] Dabigatran versus Warfarin in Patients with Atrial Fibrillation. [J].

Connolly, Stuart J. ;

Ezekowitz, Michael D. ;

Yusuf, Salim ;

Eikelboom, John ;

Oldgren, Jonas ;

Parekh, Amit ;

Pogue, Janice ;

Reilly, Paul A. ;

Themeles, Ellison ;

Varrone, Jeanne ;

Wang, Susan ;

Alings, Marco ;

Xavier, Denis ;

Zhu, Jun ;

Diaz, Rafael ;

Lewis, Basil S. ;

Darius, Harald ;

Diener, Hans-Christoph ;

Joyner, Campbell D. ;

Wallentin, Lars .

NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) :1139-1151

[7]

Diener HC, 2010, LANCET NEUROL, V9, P1157, DOI 10.1016/S1474-4422(10)70274-X

[8] Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: Executive Summary. A Statement for Healthcare Professionals From the Neurocritical Care Society and Society of Critical Care Medicine [J].

Frontera, Jennifer A. ;

Lewin, John J., III ;

Rabinstein, Alejandro A. ;

Aisiku, Imo P. ;

Alexandrov, Anne W. ;

Cook, Aaron M. ;

del Zoppo, Gregory J. ;

Kumar, Monisha ;

Peerschke, Ellinor I. B. ;

Stiefel, Michael E. ;

Teitelbaum, Jeanne S. ;

Wartenberg, Katja E. ;

Zerfoss, Cindy L. .

CRITICAL CARE MEDICINE, 2016, 44 (12) :2251-2257

[9]

Gawehn Annemarie, 2016, J Med Case Rep, V10, P269

[10] Edoxaban versus Warfarin in Patients with Atrial Fibrillation [J].

Giugliano, Robert P. ;

Ruff, Christian T. ;

Braunwald, Eugene ;

Murphy, Sabina A. ;

Wiviott, Stephen D. ;

Halperin, Jonathan L. ;

Waldo, Albert L. ;

Ezekowitz, Michael D. ;

Weitz, Jeffrey I. ;

Spinar, Jindrich ;

Ruzyllo, Witold ;

Ruda, Mikhail ;

Koretsune, Yukihiro ;

Betcher, Joshua ;

Shi, Minggao ;

Grip, Laura T. ;

Patel, Shirali P. ;

Patel, Indravadan ;

Hanyok, James J. ;

Mercuri, Michele ;

Vogelmann, O. ;

Gonzalez, C. ;

Ahuad Guerrero, R. ;

Rodriguez, M. ;

Albisu, J. ;

Rosales, E. ;

Allall, O. ;

Reguero, M. ;

Alvarez, C. ;

Garcia, M. ;

Ameriso, S. ;

Ameriso, P. ;

Amuchastegui, M. ;

Caceres, M. ;

Beloscar, J. ;

Petrucci, J. ;

Berli, M. ;

Budassi, N. ;

Valle, M. ;

Bustamante Labarta, G. ;

Saravia, M. ;

Caccavo, A. ;

Fracaro, V. ;

Cartasegna, L. ;

Novas, V. ;

Caruso, O. ;

Saa Zarandon, R. ;

Colombo, H. ;

Morandini, M. ;

Cuello, J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (22) :2093-2104

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