Letter to the Editor| Volume 367, P1-2, August 15, 2016

Download started.


Remote intracerebral hemorrhage followed by re-bleeding after intravenous thrombolysis in a patient taking a non-vitamin K antagonist oral anticoagulant: A case report

      Safety of intravenous thrombolysis for patients taking a non-vitamin K antagonist oral anticoagulant (NOAC) is not established. Herein, a patient with remote intracerebral hemorrhage (ICH) after thrombolytic therapy under NOAC treatment, is reported. The patient also presented re-bleeding after early resumption of NOAC treatment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Guidelines for the Appropriate Treatment with Intravenous rt-PA (alteplase).
        second ed. Oct 2012 (
        • Seiffge D.J.
        • Hooff R.J.
        • Nolte C.H.
        • Bejot Y.
        • Turc G.
        • Ikenberg B.
        • et al.
        Recanalization therapies in acute ischemic stroke patients: impact of prior treatment with novel oral anticoagulants on bleeding complications and outcome.
        Circulation. 2015; 132: 1261-1269
        • Shahjouei S.
        • Tsivgoulis G.
        • Bavarsad Shahripour R.
        • Jones G.M.
        • Alexandrov A.V.
        • Zand R.
        Safety of intravenous thrombolysis among stroke patients taking new oral anticoagulants-case series and systematic review of reported cases.
        J. Stroke Cerebrovasc. Dis. 2015; 24: 2685-2693
        • Mazya M.V.
        • Ahmed N.
        • Ford G.A.
        • Hobohm C.
        • Mikulik R.
        • Nunes A.P.
        • et al.
        Remote or extraischemic intracerebral hemorrhage–an uncommon complication of stroke thrombolysis: results from the safe implementation of treatments in stroke-international stroke thrombolysis register.
        Stroke. 2014; 45: 1657-1663
        • Naganuma M.
        • Mori M.
        • Nezu T.
        • Makihara N.
        • Koga M.
        • Okada Y.
        • et al.
        Intravenous recombinant tissue plasminogen activator therapy for stroke patients receiving maintenance hemodialysis: the Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry.
        Eur. Neurol. 2011; 66: 37-41
        • Paciaroni M.
        • Agnelli G.
        • Falocci N.
        • Caso V.
        • Becattini C.
        • Marcheselli S.
        • et al.
        Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: effect of anticoagulation and its timing: the RAF study.
        Stroke. 2015; 46: 2175-2182
        • Shibazaki K.
        • Kimura K.
        • Aoki J.
        • Saji N.
        • Sakai K.
        Early initiation of new oral anticoagulants in acute stroke and TIA patients with nonvalvular atrial fibrillation.
        J. Neurol. Sci. 2013; 331: 90-93
        • Kimura K.
        • Aoki J.
        • Shibazaki K.
        • Saji N.
        • Uemura J.
        • Sakamoto Y.
        New appearance of extraischemic microbleeds on T2*-weighted magnetic resonance imaging 24 hours after tissue-type plasminogen activator administration.
        Stroke. 2013; 44: 2776-2781
        • Hamann G.F.
        • del Zoppo G.J.
        • von Kummer R.
        Hemorrhagic transformation of cerebral infarction–possible mechanisms.
        Thromb. Haemost. 1999; 82: 92-94