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This issue of American Journal of Emergency Medicine presents a timely report that should be noted by all practicing emergency physicians. Nzwalo et al [1] describe a 61-year-old man with nonvalvular atrial fibrillation, taking 150 mg dabigatran twice daily for stroke protection, who presented to their emergency department (ED) with an acute ischemic stroke (AIS). The patient had a normal creatinine clearance and a normal thrombin time (TT). He was treated with intravenous recombinant tissue plasminogen activator (rt-PA) with good neurologic outcome and no bleeding complications.

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