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Intravenous thrombolysis in a patient using factor Xa inhibitor
Daniel Korya1, Haitham Dababneh1, Mohammad Moussavi1
1Contributed equally to this work.
Journal of Vascular and Interventional Neurology
|October 10, 2014
Summary
This case study reports the first use of intravenous tissue plasminogen activator (IV tPA) in a patient taking rivaroxaban, a factor Xa inhibitor, for stroke treatment. The patient experienced significant improvement, suggesting IV tPA may be safe and effective in this context.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Warfarin was the primary anticoagulant for stroke prevention in atrial fibrillation (AF).
- Newer oral anticoagulants, including direct thrombin inhibitors (e.g., dabigatran) and factor Xa inhibitors (e.g., rivaroxaban, apixaban), are now available for non-valvular AF.
- Previous reports exist for IV tPA use in patients on dabigatran, but not factor Xa inhibitors.
Purpose of the Study:
- To report the first instance of intravenous tissue plasminogen activator (IV tPA) administration in a patient on a factor Xa inhibitor (rivaroxaban).
- To assess the safety and efficacy of IV tPA in a patient with acute ischemic stroke while on rivaroxaban therapy.
Main Methods:
- A 71-year-old male patient presented with acute aphasia and right-sided weakness.
- The patient was taking rivaroxaban for stroke prevention due to non-valvular AF.
- Intravenous tissue plasminogen activator (IV tPA) was administered to the patient.
Main Results:
- The patient showed improvement following IV tPA administration.
- This represents the first reported case of successful IV tPA use in a patient treated with rivaroxaban, a factor Xa inhibitor.
Conclusions:
- IV tPA may be a viable treatment option for acute ischemic stroke in patients taking factor Xa inhibitors like rivaroxaban.
- Further research is warranted to establish the safety and efficacy of IV tPA in this patient population.
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