Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in a Stroke Patient Treated with Rivaroxaban
Autor: | Fumiaki Oka, Hirochika Imoto, Michiyasu Suzuki, Hirokazu Sadahiro, Hideyuki Ishihara, Hiroaki Torii |
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Rok vydání: | 2014 |
Předmět: |
Male
Morpholines medicine.medical_treatment Thiophenes Tissue plasminogen activator Fibrinolytic Agents Rivaroxaban Predictive Value of Tests Risk Factors Atrial Fibrillation medicine Humans Thrombolytic Therapy Infusions Intravenous Blood Coagulation Aged 80 and over Prothrombin time medicine.diagnostic_test business.industry Cerebral infarction Rehabilitation Atrial fibrillation Thrombolysis medicine.disease Recombinant Proteins Cerebral Angiography Stroke Diffusion Magnetic Resonance Imaging Treatment Outcome Tissue Plasminogen Activator Anesthesia Prothrombin Time Surgery Neurology (clinical) Drug Monitoring Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Magnetic Resonance Angiography Factor Xa Inhibitors medicine.drug Blood sampling Partial thromboplastin time |
Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 23:e457-e459 |
ISSN: | 1052-3057 |
Popis: | As limited amounts of data are available regarding thrombolytic therapy for patients taking novel oral anticoagulants, thrombolytic therapy is not recommended in such cases. Here, we report an acute stroke patient taking rivaroxaban who received intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). An 80-year-old man with a history of nonvalvular atrial fibrillation, who had been receiving 10 mg of rivaroxaban showed abrupt onset of aphasia and right hemiparesis. National Institutes of Health Stroke Scale score was 10. Onset of neurologic deficits occurred 4 hours after the last dose of rivaroxaban. Clinical data on admission were as follows: blood pressure, 170/90 mm Hg; prothrombin time (PT), 22.6 seconds (control, 12.9 seconds); international normalized ratio, 2.03; activated partial thromboplastin time, 46 seconds (normal, 23-32 seconds); and creatinine level, 1.11 mg/dL. Magnetic resonance angiography revealed occlusion of the superior trunk of the left middle cerebral artery. Intravenous infusion of .6 mg/kg of rt-PA (total dose, 36 mg) was performed 6 hours after the last rivaroxaban administration with informed consent. The neurologic deficit improved during infusion of rt-PA. Repeat brain computed tomography showed left frontal cortical infarction without hemorrhagic changes. In the case of rivaroxaban, it is difficult to accurately determine the drug activity. As the anticoagulant activity of rivaroxaban can be estimated from its pharmacokinetics and PT, it is clinically important to obtain accurate information about the timing of medication and blood sampling. |
Databáze: | OpenAIRE |
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