Successful thrombolytic therapy in acute ischemic stroke after reversal of warfarin: a case report

It is essential for acute ischemic stroke (AIS) patients to receive timely revascularization. However, intravenous thrombolysis (IVT) is not recommended for AIS patients with warfarin associated hypocoagulability. Meanwhile, monotherapy of coagulation factors or vitamin K is unable to reverse anticoagulation of warfarin in emergency. Thus, developing an effective IVT strategy poses a challenging task for these fragile population. Herein, an 82-year-old male, on regular administration with warfarin because of nonvalvular atrial fibrillation (NVAF), suffered from AIS and had an elevated international normalized ratio value of 1.72 and prolonged prothrombin time of 18.2 s at stroke onset. For normalizing INR, combination of 4 factor prothrombin complex concentrate, fresh frozen plasma and vitamin K1 were administrated. Finally, the patient successfully received recombinant tissue plasminogen activator (rt-PA), with an obviously neurological improvement. This case shows a feasible role of IVT therapy with rt-PA after reversal of coagulation regarding AIS patients with warfarin-related hypocoagulability.