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

Kermer P, Eschenfelder CC, Diener HC, Grond M, Abdalla Y, Abraham A, Althaus K, Becks G, Berrouschot J, Berthel J, Bode FJ, Burghaus L, Cangür H, Daffertshofer M, Edelbusch S, Eggers J, Gerlach R, Gröschel K, Große-Dresselhaus F, Günther A, Haase CG, Haensch CA, Harloff A, Heckmann JG, Held V, Hieber M, Kauert A, Kern R, Kerz T, Köhrmann M, Kraft P, Kühnlein P, Latta J, Leinisch E, Lenz A, Leithner C, Neumann-Haefelin T, Mäurer M, Müllges W, Nolte CH, Obermann M, Partowi S, Patzschke P, Poli S, Pulkowski U, Purrucker J, Rehfeldt T, Ringleb PA, Röther J, Rossi R, El-Sabassy H, Sauer O, Schackert G, Schäfer N, Schellinger PD, Schneider A, Schuppner R, Schwab S, Schwarte O, Seitz RJ, Senger S, Shah YP, Sindern E, Sparenberg P, Steiner T, Szabo K, Urbanek C, Sarnowksi Bv, Weissenborn K, Wienecke P, Witt K, Wruck R, Wunderlich S (2020)

Publication Type: Journal article

Publication year: 2020

Journal

DOI: 10.1177/1747493019895654

Abstract

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.

Authors with CRIS profile

Involved external institutions

Albert-Ludwigs-Universität Freiburg Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Klinikum Lippe Germany (DE) Herz-Jesu-Krankenhaus Hiltrup Germany (DE) Dietrich-Bonhoeffer-Klinikum Germany (DE) Georg-August-Universität Göttingen Germany (DE) Johannes Wesling Klinikum Minden Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Klinikum Frankfurt Höchst Germany (DE) Klinikum Landshut Germany (DE) Unfallkrankenhaus Berlin Germany (DE) Klinikum Wolfsburg Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Boehringer Ingelheim Pharma GmbH & Co. KG Germany (DE) Asklepios Klinik Altona Germany (DE) REGIOMED-KLINIKEN GmbH Germany (DE) Krankenhaus Diakovere Friederikenstift Hannover Germany (DE) HELIOS Kliniken Germany (DE) Westküstenkliniken Brunsbüttel und Heide gGmbH Germany (DE) Heilig Geist-Krankenhaus Germany (DE) Hertie-Institut für klinische Hirnforschung Germany (DE) Universitätsmedizin Greifswald / Universitätsklinikum Greifswald Germany (DE) Carl von Ossietzky Universität Oldenburg Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Klinikum rechts der Isar Germany (DE) Universitätsklinikum Mannheim Germany (DE) Klinikum Mittelbaden Baden-Baden Balg Germany (DE) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Klinikum Würzburg Mitte Germany (DE) imland Klinik Rendsburg Germany (DE) Rheinische Friedrich-Wilhelms-Universität Bonn Germany (DE) Klinikum Itzehoe Germany (DE) Universitätsklinikum Essen Germany (DE) Marienhaus Klinikum Bendorf - Neuwied - Waldbreitbach Germany (DE) Sana Kliniken Lübeck GmbH Germany (DE) Main-Kinzig-Kliniken GmbH Germany (DE) Kreiskliniken Altötting-Burghausen Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Kliniken Maria Hilf GmbH Germany (DE) Evangelische Kliniken Gelsenkirchen Germany (DE) Klinikum Kassel GmbH Germany (DE) Klinikum Fulda Germany (DE) Friedrich-Schiller-Universität Jena Germany (DE) Evangelisches Krankenhaus Königin Elisabeth Herzberge Germany (DE) Klinikum Altenburger Land Germany (DE) Universität Ulm Germany (DE) Universitätsklinikum Würzburg Germany (DE) Asklepios Kliniken Germany (DE) Heinrich-Heine-Universität Düsseldorf Germany (DE) Klinikum Main-Spessart Germany (DE)

How to cite

APA:

Kermer, P., Eschenfelder, C.C., Diener, H.C., Grond, M., Abdalla, Y., Abraham, A.,... Wunderlich, S. (2020). Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany—Updated series of 120 cases. International Journal of Stroke. https://doi.org/10.1177/1747493019895654

MLA:

Kermer, Pawel, et al. "Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany—Updated series of 120 cases." International Journal of Stroke (2020).

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