Intracerebral hemorrhage after thrombolysis with recombinant tissue plasminogen activator in a patient treated with edoxaban

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  • エドキサバン服用中に発症した急性期脳梗塞に対してrt-PA を投与し症候性脳出血を来した1 例

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Abstract

<p>We report a case of symptomatic intracerebral hemorrhage (ICH) after thrombolysis with recombinant tissue plasminogen activator (rt-PA) in a patient treated with edoxaban. An 82-year-old man consulted our hospital due to sudden onset of dysarthria and right hemiparesis. Physical examination was done in the National Institutes of Health Stroke and found the scale score of 5. His past history included atrial fibrillation, chronic kidney disease, and sick sinus syndrome. He was taking edoxaban 15 mg every morning, less than the usual dosage of 30 mg/day, to reduce the risk of hemorrhagic complication. Laboratory data on admission were unremarkable, except for elevated serum creatinine level. Head computed tomography (CT) revealed no abnormalities. Administration of rt-PA was performed at 3 h 20 min after onset and 7 h after the last intake of edoxaban. Immediately after completion of rt-PA administration, the patient became drowsy and right hemiplegia worsened. Emergent brain CT showed left putaminal hemorrhage. The ICH had enlarged by the next day, so the patient was transferred to a rehabilitation hospital with a modified Rankin scale score of 4. The retrospective review of T2*-weighted magnetic resonance imaging and magnetic resonance angiography obtained at 9 months before the stroke discovered a faint hypointense lesion in the left putamen and chronic occlusion of the left middle cerebral artery. Risk factors of ICH after thrombolysis with rt-PA are unclear in patients receiving direct oral anticoagulant. In this case, advanced age, chronic kidney disease, very recent intake of direct oral anticoagulant, and the old asymptomatic small hemorrhagic lesion may have promoted the occurrence of ICH.</p>

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