RESUMO
BACKGROUND: Rivaroxaban is an oral direct factor Xa inhibitor increasingly used in stroke prevention in nonvascular atrial fibrillation, primary prevention and treatment of venous thromboembolism, and secondary prevention in acute coronary syndromes. METHODS: Thrombolytic treatment has established efficacy in acute ischemic stroke. RESULTS: We report the case of a 76-year-old female under rivaroxaban for paroxysmal nonvalvular atrial fibrillation who presented an acute ischemic stroke. The brain magnetic resonance imaging diffusion-weighted sequences showed increased signal in the territory of the left middle cerebral artery. Platelet count was normal. PT was 55% (normal, 70-120); the international normalized ratio was 1.51 (normal, .90-1.40). She underwent intravenous thrombolysis 210 minutes after stroke onset without bleeding complication and with complete clinical recovery. CONCLUSIONS: This case underlines the need for further studies on the safety of thrombolysis in stroke patients taking rivaroxaban. Our case emphasizes the urgent need for sensitive coagulation bed-side tests during stroke emergencies.