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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 distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

lingua: Inglese

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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