Meta-analysis suggests idarucizumab-enabled thrombolysis is feasible for dabigatran-treated stroke patients after AF ablation.

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Frontiers in Medicine Published April 22, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Meta-analysis suggests idarucizumab-enabled thrombolysis may be feasible for selected dabigatran-treated stroke patients.

This publication is a meta-analysis combined with a case report review focusing on dabigatran-treated patients who experienced periprocedural acute ischemic stroke after radiofrequency catheter ablation for atrial fibrillation. The scope includes the safety and efficacy of idarucizumab-enabled intravenous thrombolysis compared to non-anticoagulated thrombolysis populations. The review synthesizes secondary outcomes including intracranial hemorrhage, mortality, and favorable functional outcomes defined as a modified Rankin Scale score of 0 to 2.

The authors report low rates of intracranial hemorrhage and low mortality. Favorable functional outcomes were described as comparable to those seen in standard thrombolysis populations. However, specific effect sizes, absolute numbers, p-values, and confidence intervals were not reported for these outcomes. Additionally, adverse events, serious adverse events, discontinuations, and tolerability data were not reported in the source material.

The follow-up duration for these outcomes was 90 days. The authors note that early anticoagulant reversal followed by prompt reperfusion therapy may represent a feasible and safe therapeutic strategy in carefully selected patients. Given the absence of reported absolute numbers and the observational nature of the included case reports, the certainty of these findings is limited. This evidence should be interpreted with caution regarding broad clinical application.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

IntroductionPeriprocedural stroke represents a clinically important complication of atrial fibrillation ablation, and effective anticoagulation remains essential for risk reduction. However, the use of intravenous thrombolysis in patients with acute ischemic stroke who have recently received novel oral anticoagulants remains controversial under certain clinical circumstances. This report described an uncommon case of radiofrequency ablation-related ischemic stroke treated with intravenous thrombolysis after dabigatran reversal with idarucizumab. In parallel, we conducted a systematic review and meta-analysis to evaluate the safety and outcomes of this treatment strategy.MethodsThis study included analysis of an index case and a systematic review with meta-analysis. We report a 54-year-old patient who developed acute ischemic stroke shortly after radiofrequency catheter ablation for AF and was treated with intravenous thrombolysis after dabigatran reversal with idarucizumab. In parallel, a systematic literature search was conducted to identify observational studies, cohorts, and case series reporting idarucizumab-enabled thrombolysis in dabigatran-treated stroke patients. Data on intracranial hemorrhage (ICH), favorable functional outcome [modified Rankin Scale (mRS) 0–2], and mortality were extracted. Pooled estimates were calculated using random-effects meta-analysis of proportions, and comparative analyses with non-anticoagulated thrombolysis populations were performed using pooled risk ratios.ResultsNeuroimaging confirmed an acute cerebral infarction in the left thalamus. The patient had been receiving dabigatran and was treated with intravenous idarucizumab followed by intravenous alteplase. Neurological deficits rapidly improved after thrombolysis, and the patient achieved a favorable recovery over 90 days of follow-up.DiscussionFindings from the systematic review and meta-analysis demonstrated low rates of intracranial hemorrhage, low mortality, and favorable functional outcomes comparable to standard thrombolysis populations. This case, together with accumulating evidence from the literature, supports the short-term safety and clinical effectiveness of idarucizumab-enabled intravenous thrombolysis in dabigatran-treated patients with periprocedural acute ischemic stroke. Therefore, early anticoagulant reversal followed by prompt reperfusion therapy may represent a feasible and safe therapeutic strategy in carefully selected patients.