Endovascular thrombectomy for an acute ischemic stroke patient taking dabigatran

Abstract

We report a case of stroke in a patient taking dabigatran (150 mg twice daily) for management of atrial fibrillation. A 58-year-old man presented to our emergency department 35 min after onset of acute right hemiparalysis, conjugate deviation to the left, and aphasia (National Institutes of Health Stroke Scale score, 21). The patient had taken his last dose of dabigatran 4 hours before the onset of symptoms. Noncontrast computed tomography (CT) of the brain showed subtle, early obscuration of the left anterior lobe, insular cortex, and temporal lobe. We diagnosed acute ischemic stroke. CT angiography showed thrombotic occlusion of the left MCA (M2 segment). We did not administer recombinant tissue plasminogen activator, given the patient’s recent dabigatran use. The patient satisfied the criteria for endovascular therapy, and the procedure was begun at 108 min after onset. We obtained perfect recanalization, which resulted in rapid symptomatic improvement. Present guidelines offer no guidance regarding the safety of treatments for acute ischemic stroke in patients taking dabigatran. The present results suggest that endovascular therapy is a suitable treatment for such patients.