Idarucizumab for Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Stroke: A Case Report

Non –vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran, are widely used to prevent ischemic stroke in patients with nonvalvular atrial fibrillation. Nonetheless, stroke occurs in 1–2% of patients, and the use of NOACs may increase the bleeding risk for patients who are receiving a cute treatment of intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT). Idarucizumab, a monoclonal antibody developed to bind dabigatran, has been proven safe and effective for patients with uncontrolled bleeding or for patients planning to receive emergent procedures.
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Selected Topics: Neurological Emergencies Source Type: research

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CONCLUSIONS: Compared to warfarin, NOACs were associated with a significantly lower risk of adverse events, with heterogeneity in treatment effects among different age strata. Overall, the clear safety signal in favor of NOACs over warfarin was evident irrespective of age strata, being most marked in the most elderly. PMID: 31809694 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
AbstractThe best strategy in atrial fibrillation (AF) after  >  12 months after an acute coronary syndrome or in patients with chronic coronary syndrome without an indication for interventional revascularization remains unclear. European guidelines generally recommend therapy with oral anticoagulation (OAC) alone, whereas North American guidelines advise com bination therapy consisting of OAC plus antiplatelet therapy in some patients. We performed a meta-analysis of available trials comparing these treatment strategies. The primary endpoint was major adverse cardiac events (MACE), secondary endp...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
AbstractSeveral studies have explored the use of NOACs compared with vitamin K antagonists (VKAs) in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF); and therefore, we aimed to compare the efficacy and safety outcomes of NOACs with VKAs in this population. We systematically searched the PubMed and Embase databases until August 5, 2019 for studies that compared the effect of NOACs with VKAs in patients with HCM and AF. The risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. A total of four observational studies were included in this meta-analysis. Over...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
CONCLUSION:  In AF patients with malignancy, NOACs appear at least as effective as VKAs in preventing thrombotic events and reduce intracranial bleeding. NOACs may represent a valid and more practical alternative to VKAs in this setting of high-risk patients. PMID: 31785599 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
CONCLUSIONS: We observed low rates of bleeding and adverse drug reactions. However, rates of mortality and discontinuation were relatively high. These results could possibly be explained by the real-world nature of the data including higher-risk patients. PMID: 31773474 [PubMed - as supplied by publisher]
Source: Netherlands Heart Journal - Category: Cardiology Authors: Tags: Neth Heart J Source Type: research
Publication date: Available online 12 November 2019Source: Canadian Journal of CardiologyAuthor(s): Mohammed Shurrab, Asaf Danon, Sami Alnasser, Benedict Glover, Anna Kaoutskaia, Mark Henderson, David Newman, Eugene Crystal, Dennis KoAbstractBackgroundThe choice of antithrombotic therapy for atrial fibrillation (AF) patients who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is challenging. We aimed to assess outcomes between dual antithrombotic therapy with DOACs plus an antiplatelet agent (Dual therapy) in comparison to warfarin plus two antiplatelet agents (Triple therap...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
In conclusion, current published data suggest that th e use of reduced-dose NOACs is non-inferior to warfarin in patients with AF (in particular Asians).
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
AbstractStroke is ranked as the second leading cause of death worldwide. Ischemic stroke commonly results from emboli that originate in the heart among high-risk patients, such as those who develop atrial fibrillation. Yet, treatment is currently limited to anticoagulants, which may be associated with life-threatening bleeding. Our aim was to develop an alternative, device-based approach for continuous stroke prevention in high-risk patients. To this end, a novel endovascular tubular mesh was designed to be implanted in the aortic arch and to reroute emboli away from critical cerebral arteries. The feasibility of this appr...
Source: Journal of Cardiovascular Translational Research - Category: Cardiology Source Type: research
Conclusions: Research on the long-term comparative effectiveness, safety, and effects on quality of life between rivaroxaban and other novel oral anticoagulants is urgently needed.
Source: American Journal of Therapeutics - Category: Drugs & Pharmacology Tags: Review Source Type: research
This study evaluated and compared the safety outcomes of DOACs versus warfarin in patients with non-valvular AF and concomitant CKD. Patients in our health system with AF prescribed oral anticoagulants during 2010 to 2017 were identified. All-cause mortality, bleeding, and hemorrhagic and ischemic stroke were evaluated based on degree of renal impairment and method of anticoagulation.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
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