Intravenous thrombolysis with rt-PA in a cardiogenic cerebral embolism patient during anticoagulant therapy with rivaroxaban

Abstract

We report a case of ischemic stroke during anticoagulant therapy with rivaroxaban who underwent intravenous thrombolysis with rt-PA. A 78-year-old-woman presenting right hemiparesis and motor aphasia was admitted to our hospital. MRI (DWI) showed a hyper-intensity area in the left frontal lobe. Since more than 18 hours had passed after last intake of rivaroxaban and the prothrombin time was 91%, so its blood concentration and anticoagulant effect were assumed low. Therefore rt-PA was administered 3 hours and 40 minutes after the onset. Right hemiparesis was improved and she was discharged with a mild speech disturbance. Safety of rt-PA administration might be assessed by elapsed time from last intake of rivaroxaban.