Mechanical Thrombectomy for Acute Ischemic Stroke in a Patient Treated with Dabigatran

Newer anticoagulants such as dabigatran have been widely used for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation (AF). A 64-year-old man treated with dabigatran 110 mg twice daily for chronic AF presented with total aphasia, right homonymous hemianopsia, and right hemiparesis at 90 minutes after the last intake. His prothrombin time-international normalized ratio (PT-INR) was 1.14 (normal range: 0.7-1.5) and activated partial thromboplastin time (aPTT) was 33.8 seconds (normal range: 24-38 seconds). Clotting activity could not be measured because of the dabigatran intake; however, clotting activity was predicted to increase to its highest level at 90-120 minutes after the last dabigatran dose. Angiography results showed total occlusion of the left middle cerebral artery (MCA), and mechanical thrombectomy with the Penumbra System (Penumbra, Inc. ) was performed instead of intravenous administration of recombinant tissue plasminogen activator (rt-PA). The patient showed recanalization of the MCA and neurological improvement. Mechanical thrombectomy can be used as a supplement to intravenous administration of rt-PA for the treatment of acute ischemic stroke in patients receiving newer anticoagulants such as dabigatran. The indication of thrombolysis for acute ischemic stroke in patients taking dabigatran should be discussed after considering the aPTT value and the time since the last intake of dabigatran.