The intravenous administration of recombinant tissue plasminogen activator (tPA) is the only specific treatment that has been approved for acute ischaemic stroke with class I recommendation and evidence level A. Its use is contraindicated in patients on treatment with coumarin anticoagulants with an international normalised ratio (INR)> 1.7 due to the increased risk of bleeding in these cases (1). Dabigatran an oral anticoagulant that is a direct inhibitor of thrombin. Its predictable pharmacokinetic profile allows for a fixed-dose regimen with no need for coagulation monitoring. It has been shown to be effective in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, with a lower risk of bleeding complications than coumarins (2). However, no data are available on the risk of bleeding associated with thrombolysis in patients on treatment with dabigatran.

We present the case of a 76-year-old, hypertensive, diabetic woman with a knee prosthesis who presented aphasia and right-sided hemiplegia of sudden onset. She had undergone surgery for a periprosthetic fracture three months earlier. The drug history only revealed long-term treatment with oral antidiabetic and antihypertensive agents. On arrival at the hospital, the patient had a blood pressure of 230/100 mmHg which was treated with urapidil, 25 mg intravenously. She presented motor