Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan.

BACKGROUND: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. METHODS: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies. RESULTS: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality. CONCLUSION: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.

540° versus 360° barbecue rotation for HSC-canalithiasis.

BACKGROUND: There are some variations of barbecue rotation to treat canalithiasis of horizontal semicircular canal (HSC-canalithiasis). But a 540° approach has never been reported. OBJECTIVE: To compare a modified 540° to a traditional 360° barbecue rotation for treatment of HSC-canalithiasis. METHODS: Sixty consecutive patients with HSC-canalithiasis were prospectively allocated to two groups of log roll treatment, either 540° or 360° barbecue rotation (Br540 or Br360). Only one application was allowed in each visit, with weekly repetitions until the resolution of positional nystagmus and vertigo. RESULTS: In each group, 2 patients were lost to follow-up so that 28 were analyzed. With "multi-canal sufferers" or "canal switchers" included, 25, 2, and 1 patients in the Br540 needed 1, 2 and 4 canalith repositioning procedures (CRP) respectively to cure the HSC-canalithiasis, while 17, 6, 5 in the Br360 required 1, 2 and 3 CRPs (p = 0.011). With "multiple canal sufferers" and "canal switchers" excluded from analysis, 19, 1, and 1 patients in the Br540 needed 1, 2 and 4 CRPs respectively, while 16, 6, 4 in the Br360 required 1, 2 and 3 CRPs (p = 0.027). The success rate with one application was higher in the 540° group than the 360° group, about 90% versus 61% (P < 0.05 in both analyses). CONCLUSION: A 540° barbecue rotation is probably superior to 360° for treatment of HSC-canalithiasis.