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Italian Journal of Emergency Medicine 2020 April;9(1):52-4

DOI: 10.23736/S2532-1285.20.00004-X

Copyright © 2020 THE AUTHORS

This is an open access article under the CC BY-NC-ND license

language: English

Thrombolytic therapy and use of apixaban in a stroke patient

Saverio DRAGONI 1 , Claudio POGGIONI 1, Fabrizio BOTTINO 1, Matteo MAZZETTI 2, Andrea BAGLIONI 1, Simone NOCENTINI 1

1 Department of Emergency Medicine, Santa Maria della Gruccia Hospital, Montevarchi, Arezzo, Italy; 2 Department of Internal Medicine, Santa Maria della Gruccia Hospital, Montevarchi, Arezzo, Italy



We present a case of a woman with a stroke successfully treated with rt-PA. After the administration of the fibrinolytic agent we accidentally discovered that the patient was taking apixaban 5 mg b.i.d. for her chronic atrial fibrillation. Despite the high dosage of anticoagulant administered no major bleeding occurred and the neurological deficit completely recovered. The most recent AHA/ASA guidelines do not recommend the use of rt-PA in patients taking direct oral anticoagulants (DOAC) but data from literature seem to suggest that such administration is not associated with an increased risk of mayor bleedings. Current report underlines the urgent need for new studies to evaluate the possibility of treating DOAC patients with fibrinolytic drugs.


KEY WORDS: Stroke; Tissue plasminogen activator; Apixaban; Thrombolytic therapy

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