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
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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