Letter by Casado-Naranjo et al Regarding Article, “Using Dabigatran in Patients With Stroke: A Practical Guide for Clinicians”
To the Editor:
We read with great interest the article by Alberts et al1 who performed an excellent review on the use of dabigatran in patients with stroke to provide a clinical practice guideline. In the section that deals with the use of intravenous tissue-type plasminogen activator in a patient treated with dabigatran, they say that although clinical experience is too limited, no bleeding complications have been reported. We would like to make a precision to their exposition.
To date only 2 patients who had an acute stroke at the time of taking dabigatran and were treated with intravenous tissue-type plasminogen activator have been communicated2,3 and although the clinical outcome was diverse, bleeding complications did not appear. Based on this information we performed intravenous thrombolysis to a patient in similar circumstances with the result of a fatal intracerebral hemorrhage.4
Taking this into account, we recommend caution and we agree that in the absence of an antidote is not reasonable to treat such patients with intravenous tissue-type plasminogen activator.
Ignacio Casado-Naranjo, MD
Juan Carlos Portilla-Cuenca, MD
Pedro Enrique Jiménez-Caballero, MD
Department of Neurology
Hospital San Pedro de Alcántara
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- © 2012 American Heart Association, Inc.
- Alberts MJ,
- Bernstein RA,
- Naccarelli GV,
- Garcia DA
- Casado Naranjo I,
- Portilla-Cuenca JC,
- Jiménez Caballero PE,
- Calle Escobar ML,
- Romero Sevilla RM