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Updated: Mar 14, 2026

Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Successful thrombolysis with recombinant tissue plasminogen activator after antagonizing dabigatran by idarucizumab:
Annemarie Gawehn1,2, Yassine Ayari1,2, Christian Heuschkel1,2
1Department of Neurology, Nordwest-Krankenhaus Sanderbusch GmbH, Am Gut Sanderbusch 1, 26452, Sande, Germany.
Background:
Effective anticoagulation routinely precludes patients from receiving intravenous thrombolysis with recombinant tissue plasminogen activator to reverse severe symptoms of ischemic stroke. We report what we believe to be the first case of ischemic stroke successfully treated with recombinant tissue plasminogen activator after antagonizing dabigatran with the monoclonal antibody idarucizumab, recently approved worldwide.
Case Presentation:
A 75-year-old Caucasian man presented to our hospital with severe aphasia and mild hemiparesis. After providing written consent, he received two doses of 2.5 g of idarucizumab over 20 minutes followed by standard protocol in-label recombinant tissue plasminogen activator application. All symptoms resolved within 1 h.
Conclusions:
Applying a recombinant tissue plasminogen activator after antagonizing dabigatran with idarucizumab is feasible and easy to manage in an emergency room or stroke unit. Thus, idarucizumab represents a new therapeutic option for patients receiving dabigatran treatment, reestablishing their eligibility for recombinant tissue plasminogen activator thrombolysis.
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