5 Both centers participated in the Dose Comparison of Intravenous Tenecteplase before Thrombectomy for Ischemic Stroke trial 8 with Royal Adelaide Hospital patients only receiving tenecteplase as part of this trial. The change from alteplase in Christchurch was driven by lack of thrombectomy coverage and data suggesting that tenecteplase may result in improved early recanalization. Tenecteplase became the standard treatment for stroke thrombolysis in Christchurch Hospital in July 2018. Consecutive patients from Christchurch Hospital, New Zealand, and the Royal Adelaide Hospital, Australia who received tenecteplase thrombolysis after idarucizumab for dabigatran reversal were included in the present series. The data that support the findings of this study are available from the corresponding author upon reasonable request. 7 We expand on this experience by reporting 13 further patients with ischemic stroke treated with intravenous tenecteplase after idarucizumab dabigatran reversal. Intravenous thrombolysis with tenecteplase after dabigatran reversal has been reported in one single case report. 4 Tenecteplase is highly likely to be at least noninferior to alteplase, 6 although confirmatory trials are continuing. 3, 4 Intravenous tenecteplase (0.25–0.40 mg/kg) increased rates of early recanalization in patients with intracranial large vessel occlusion 5 and was safe in patients with minor stroke when compared with standard dose alteplase. Tenecteplase is a genetically modified form of alteplase with higher fibrin specificity and longer half-life administered as a single bolus. 2 While unreversed anticoagulation is a thrombolysis contraindication, limited literature suggests that idarucizumab administration before intravenous alteplase in acute ischemic stroke is safe. Idarucizumab is a monoclonal antibody with high affinity for dabigatran and has been shown to provide rapid and permanent anticoagulant reversal in patients treated with dabigatran. 1 Unlike vitamin K antagonists, it requires no anticoagulant monitoring, and the anticoagulant effect is established rapidly. Customer Service and Ordering InformationÄabigatran is an effective and commonly prescribed treatment for atrial fibrillation thromboprophylaxis.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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