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1. Intravenous Thrombolytic Treatment in the Oldest Old

Author

Juan García-Caldentey, María Alonso de Leciñana, Patricia Simal, Blanca Fuentes, Gemma Reig, Fernando Díaz-Otero, Marta Guillán, Ana García, Patricia Martínez, Andrés García-Pastor, José Antonio Egido, Exuperio Díez-Tejedor, Antonio Gil-Núñez, José Vivancos, and Jaime Masjuan

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Background and Purpose. Intravenous thrombolysis using tissue plasminogen activator is safe and probably effective in patients >80 years old. Nevertheless, its safety has not been specifically addressed for the oldest old patients (≥85 years old, OO). We assessed the safety and effectiveness of thrombolysis in this group of age. Methods. A prospective registry of patients treated with intravenous thrombolysis. Patients were divided in two groups (

Published
2012
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2. Safety and outcome of intravenous thrombolysis with rtPA in patients with atrial fibrillation

Author

Elena Terecoasa, Cristina Tiu, Marta Guillan, Victor Sanchez-Gonzalez, Maria Alonso de Lecinana, and Jaime Masjuan

Subjects
thrombolysis, rtpa, atrial fibrillation, cardioembolic stroke, outcome, safety, Medicine, Neurology. Diseases of the nervous system, RC346-429
Abstract

Background and purpose. Intravenous administration of recombinant tissue plasminogen activator (rtPA) is approved for the treatment of patients with acute ischemic stroke. It is still controversial if in patients with ischemic stroke due to atrial fibrillation this treatment has the same efficacy as in patients with ischemic stroke due to other etiologies. The present study aimed to compare the safety and outcome of intravenous thrombolysis with rtPA between patients with stroke due to atrial fibrillation, due to other cardiac sources of emboli and due to large-vessel disease. Methods. Retrospective analysis of 463 patients treated with rtPA in the Stroke Unit of Ramon y Cajal University Hospital, Madrid, between January 2004 and December 2011. Patients were divided in three subgroups according to stroke etiology: cardioembolic stroke due to atrial fibrillation, cardioembolic stroke due to a cardiac disease other than atrial fibrillation, stroke due to large-vessel disease. The outcome measures of the study were: symptomatic intracranial hemorrhage transformation, modified Rankin score and mortality at three months. Results. The results of the multivariate analysis showed that stroke etiology has no influence on functional outcome (p = 0.181), symptomatic intracranial hemorrhage (p = 0.093) and mortality at three months (p = 0.091). Age and baseline NIHSS scores are independent predictors for both functional outcome and mortality. Conclusion. Stroke outcome after intravenous thrombolysis with rtPA is not influenced by the stroke etiology.

Published
2012
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3. Times to endovascular treatment following two triage models

Author

Jose Fernandez-Ferro, Marta Guillan Rodriguez, Manuel Perez Marquez, Jorge Escartin Lopez, Maria Teresa Cerdan Carbonero, Maria Jesus Garcia de Yebenes, Natalia Barbero Bordallo, Maria Jesus Garcia Sanchez, Eduardo Rojo Perez, and Claudio Rodriguez Fernandez

Subjects
Patient Transfer, Endovascular Procedures, Dermatology, General Medicine, Brain Ischemia, Time-to-Treatment, Stroke, Psychiatry and Mental health, Treatment Outcome, Humans, Thrombolytic Therapy, Neurology (clinical), Triage, Ischemic Stroke, Retrospective Studies, Thrombectomy
Abstract

Debate is ongoing regarding the best service model for achieving a prompt recanalization in LVO ischemic stroke with an indication for thrombectomy. We aim to assess differences between two of the existing models within our region.We work in a cluster of three public hospitals (one hub and two spokes) forming a single functional neurology service in Madrid (Spain). Upon a LVO case out of regular hours, the interventional neuroradiologist drives to the hub hospital following the drive-the-doctor paradigm (DD). For any of the spokes, the patient is transferred to the nearest endovascular-capable hospital (drip-and-ship-DS) following the Madrid Stroke Plan. We compared times to endovascular procedures between cases managed under each model.Thirty-eight patients in the period April 2014-March 2021 meet the inclusion criteria (DD 27; DS 11). While baseline characteristics are comparable between groups, we observed a notable difference in the time delays favoring those managed under the DD model; with differences between median times of 105 min for hospital arrival-groin puncture (DD 140 [110-181]; DS 245 [222-310], p 0.0004); 122 min for CT-groin puncture (DD 100 [85-144]; DS 222 [200-255], p = 0.0001); and 98 min for hospital arrival-recanalization (DD 180 [140-209]; DS 278 [241-360], p = 0.0014). No differences were observed for NIHSS or mRS on discharge.Compared to the drip-and-ship, the drive-the-doctor triage model for patients with LVO ischemic stroke in primary centers seems to guarantee a shorter time to the start of the endovascular procedure and to recanalization in our region.

Published
2022
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4. Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient

Author

Jose Fernandez-Ferro, Víctor Manuel Suárez-Vega, Celina Cabrera-Rojo, Sara Bellido, Concepcion Perez-Jorge Peremarch, Marta Guillan, Maria Aragones-Garcia, and Javier Villacieros-Álvarez

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), macromolecular substances, 030204 cardiovascular system & hematology, Ischaemic stroke etiologies, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Ischaemic stroke, Coagulopathy, Medicine, Cerebral infarcts, Multiple cerebral infarcts, Acute ischemic stroke, COVID, business.industry, Cerebral infarction, SARS-CoV-2, Ischemic strokes, Hematology, medicine.disease, Coronavirus disease, 030220 oncology & carcinogenesis, Cardiology, business, Multivessel cerebral infarction, Intrathecal inflammation
Abstract

Highlights • In the occurrence of new-onset neurological symptoms in COVID-19 patients, we should suspect an acute ischemic stroke and not assume that it is secondary to the respiratory syndrome (hypoxia). Acute ischaemic stroke continues to be a treatable medical emergency also during the SARS-CoV-2 pandemic. • Arterial thrombotic events may not only occur as a complication in severe cases of COVID-19; but can also appear in mild-moderate cases due to other mechanisms. • Several pathogeneses may be behind ischemic strokes in COVID-19, in addition to the more evident coagulopathy associated with the severe infection.

Published
2020

5. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study

Author

Cristina Barbagelata, Francisco Cabrera, María Herrera, Pedro Cardona, Radka Ivanova Georgieva, José Miguel Pons, Maite Martínez, Jesús Saiz, Tomás Pérez, José Ángel Satué, Cristina Tejera Pérez, Joan Rosal, Javier Fernández, M. José Gómez, Jordi Sanahuja, Patricia Ibáñez, Ana Rodríguez, José M. Errea, Alejandro Martínez-Domeño, Antonio Manquillo, Ana Latorre, Luis Beltrán, Juli Font, Cecile van Eedenburg, Xavier Ustrell, Elena Bello, Raquel González, M. Carmen Gil, José Antonio Díaz, Francisco Purroy, Elena Calzado, José Carlos Gómez, Susana Arias, Clara Sainz, Óscar Fabre, Francisco Javier Barrero, José Ferreiro, José M. Ramírez-Moreno, Mariano Aguayo, Lamberto Landete, Manuel Rodríguez, Ramón Villaverde, Eduardo Agüera-Morales, C. Suárez Fernández, José Ramírez, Gemma Reig, Covadonga Fernández, Carmen Jiménez, Ana M Roa, Alejandro Ponz, Joaquín Carnedo, Rafael Fernández de la Puerta, Jerzy Kuprinski, Raquel Chamarro, Enrique Cabrerizo, Rafael López, M. Ángeles Revilla, Xavier Nogués, Marta Serrano, Roberto Muñoz, José M. Trejo, Jaume Roquer, Beatriz Zandio, María Pérez de la Blanca, Santiago Montull, Helena Quesada, Juan Carlos Anglada, Ana de Arce, Ana Pampliega, Juan Carlos Belinchón, Jaime Gállego, Francisco Moniche, Inmaculada Villegas, Nuria Aymerich, Juan José Mengual, Ana Calleja, Antonio Gil-Núñez, Antonio Medina, Fernando Salgado, Antonio Pose, Blanca Batalla, Sandra Boned-Riera, Juan José Cara, José M. Terrero, Juan Luengo, Román Cerro, José Tembl, Laia Seró, Christian Homedes, Manuel Payan, Imma Cañas, Blanca Fuentes, Fernando Díaz, Laura Ballester, Francisco Lozano, Ignacio Casado, M. Pilar Moreno, Luis López, Antonio Arjona, Miguel Yebra, Jorge Romero, Marco Antonio Budiño, Francesc Puchades, Jacinto Hernández, Javier García, María Concepción Prados Sánchez, Joan Martí-Fàbregas, José Castro, M. Ángeles Fidalgo, Javier Marta, Alicia de Felipe, David Esteva, María Bestué, Vicente Oliver, Marta Guillan, David Vinuesa García, Esther Aragón, Natividad Raña, José Maciñeiras, José Luis Vázquez, Juan Carlos Martínez-Acitores, Dolores Fernández, Félix González, Demetrio Sánchez, Rafael Bustamante, María Ángeles Ortega, Nuria Navarrete, Jesús M. Juega, Emilio Barroso, Pedro Luis Muñoz, Leticia Álvarez, Mónica Arias, Carlos Sánchez, Juan Antonio Arroyo, Juan José Timiraos, Ana Jurado, José Carlos Pontes, Sonia M. García, Iluminada García Polo, Daniel Irigoyen, Arturo Artero, Maria Àngels Font, Miguel Ángel Rico, Laura Imaz, Salvadora Martínez, José Carlos Fernández, Ikram Benabdelhak, Ana María González, Patricia Martínez, Sonia Huertas, Francisco Javier Martínez, Yolanda Bravo, Alfonso Aguirre, Luis Mérida, Carlos Tejero, Jordi Espinosa, Montserrat González, Consuelo Matute, José M. de Lis, Marian Muchada, José Bernardo Escribano, M. Dolores Moragues, Miguel Ángel Corrales, Mar Freijo, Juan F. Arenillas, J. Manuel Cerqueiro, Aida Lago, Manuel Montero, Enrique Mostacero, Javier de la Torre, Jesús Foronda, David Gorriz, Óscar Fernández, Elisa Rodríguez, Alex Culla, José M. Rivera, Juan Carlos Portilla, Roberto Pérez, Marta Pena, Bárbara Vives, Julián Fernández, Jose Antonio Egido, Ana Castellano, Mónica Zamora, Agustín Pijierro, Eva Calvo, Elisa Cortijo, Fernando Aguilar, David Cánovas, José Vivancos, Pablo Irimia, Enrique Calderón, Carlos Molina, Pedro Jesús Serrano, Esther Fernández, J. Tejada, Carmen Morata, María Paz Martínez, Gerardo Ruiz, César Lucas, Purificación Durán, Ángel Ois, Noemí Díez, José Antonio Tamayo, Jordi Casanova, Igor Molina, Jaime Díaz, Carmen Caro, Susana Mederer, Fernando Jaén, Jordi Estela, Dionisio Carrillo, Irene Navalpotro, José Luis Beato Pérez, Alain Luna, Jorge Artal, Jesús Cantero, Enrique Palacio, Elisa Cuadrado, Javier Reyes, Pilar Meler, Miguel Alberto de Zarraga, Gema Sanz, M. Ángeles López, Ricardo Gómez, Joaquín Sánchez, Miguel Ángel García, Raúl Quirós, Rosario Gil, Héctor Guerrero, Jorge Marrero, Eduardo Carmona, José Carlos Morán, José Antonio Trujillo, Alan Flores, Juan Manuel García, Manuel Gómez-Choco, Amparo Romero, Carlos Vilar, Santiago Freire, M. del Mar Castellanos, Silvia Tur, Cristina Borrachero, Jesús Vega, Sonia Gonzalo, Alberto Morán, Laura Ramos, Antonio Cayon, Manuel Seijo, Raquel Delgado-Mederos, M. José Fonseca, Juan Girón, Aida Rodríguez, Yesica Miranda, Jaime Masjuan, Álvaro González, Iván Moreno, Fernando Sierra, Jordi Jiménez, M. del Carmen Riveira, Davinia Larrosa, Rosa Díaz, Daniel Peña, M.M. Contreras Muruaga, Joaquín Antón, Irene Escudero, Borja Enrique Sanz, and Antoni German

Subjects
medicine.medical_specialty, Acenocoumarol, Neurology, business.industry, Warfarin, Atrial fibrillation, General Medicine, 030204 cardiovascular system & hematology, Vitamin k, medicine.disease, Thromboembolic risk, 03 medical and health sciences, 0302 clinical medicine, Multicenter study, Diabetes mellitus, Internal medicine, medicine, 030212 general & internal medicine, business, medicine.drug
Abstract

Objective To identify factors associated with poor anticoagulation control with vitamin K antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. Methods Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6 months before the inclusion. Results Out of 1337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6 months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94 ± 1.54; 3.10 ± 1.26; 4.63 ± 1.54, and 2.20 ± 0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95% CI: 1.144–5.659), prior labile INR (OR: 35.371; 95% CI: 15.058–83.083) and the determination of >6 INR controls in the last 6 months (OR: 4.747; 95% CI: 2.094–10.759), and according to the Rosendaal method, with prior labile INR (p Conclusions Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6 INR controls and HAS-BLED.

Published
2018
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6. Factores asociados al mal control de la anticoagulación con antivitamina K en pacientes con fibrilación auricular no valvular atendidos en consultas de Medicina Interna y Neurología. Estudio ALADIN

Author

M.M. Contreras Muruaga, G. Reig, J. Vivancos, A. González, P. Cardona, J.M. Ramírez-Moreno, J. Martí-Fábregas, C. Suárez Fernández, Antonio Pose, José Antonio Díaz, Manuel Rodríguez, Marta Pena, Susana Arias, Davinia Larrosa, Álvaro González, Elisa Rodríguez, Montserrat González, Dolores Fernández, Cristina Barbagelata, Natividad Raña, Santiago Freire, J. Manuel Cerqueiro, Héctor Guerrero, Laura Ramos, Leticia Álvarez, José M. de Lis, Carmen Caro, Manuel Seijo, Susana Mederer, Miguel Alberto de Zarraga, José Ferreiro, José M. Terrero, Mónica Arias, Roberto Pérez, Joaquín Sánchez, José Maciñeiras, Julián Fernández, Fernando Jaén, David Esteva, Mónica Zamora, Nuria Navarrete, Javier García, Luis Mérida, Miguel Ángel Corrales, Raúl Quirós, Jesús Cantero, Francisco Javier Barrero, Inmaculada Villegas, José Castro, Jesús Foronda, Dionisio Carrillo, Jesús Vega, José Antonio Trujillo, Manuel Montero, Ana Jurado, Carlos Sánchez, Eduardo Agüera-Morales, María Sánchez, Purificación Durán, Rafael Fernández de la Puerta, María Pérez de la Blanca, María Paz Martínez, Óscar Fernández, José Antonio Tamayo, Rafael Bustamante, Pedro Jesús Serrano, Antonio Arjona, Javier Fernández, Manuel Payan, Ricardo Gómez, Daniel Peña, Enrique Cabrerizo, Fernando Salgado, Radka Ivanova Georgieva, Antonio Gil-Núñez, Elena Bello, Fernando Díaz, Antonio Medina, Ana Castellano, Yesica Miranda, Óscar Fabre, Iluminada García Polo, Patricia Ibáñez, Clara Sainz, Fernando Sierra, Esther Aragón, Jaime Díaz, Fernando Aguilar, María Ángeles Ortega, José Antonio Egido, José Carlos Pontes, Miguel Ángel García, Francisco Cabrera, Blanca Batalla, Alex Culla, Carlos Molina, Alan Flores, Laia Seró, Marian Muchada, Pilar Meler, Sandra Boned-Riera, David Cánovas, Jordi Estela, Juli Font, Francisco Purroy, Ikram Benabdelhak, Jordi Sanahuja, Jaume Roquer, Ana Rodríguez, Ángel Ois, Elisa Cuadrado, Jordi Jiménez, Xavier Nogués, Jerzy Kuprinski, Antoni German, Daniel Irigoyen, Juan José Cara, Maria Àngels Font, Sonia Huertas, Alejandro Martínez-Domeño, Juan Antonio Arroyo, Raquel Delgado-Mederos, Manuel Jesús Gómez-Choco, Juan José Mengual, Sonia M. García, M. del Mar Castellanos, Cecile van Eedenburg, Imma Cañas, Jordi Espinosa, Santiago Montull, Helena Quesada, Xavier Ustrell, Christian Homedes, Irene Navalpotro, Jordi Casanova, Aida Pilar Lago, Carmen Morata, David Gorriz, Iván Moreno, José Tembl, Alejandro Ponz, M. José Fonseca, Raquel Chamarro, Rosario Gil, Vicente Oliver, Ana Pampliega, Arturo Artero, Francesc Puchades, Lamberto Landete, Carlos Vilar, Carmen Jiménez, Bárbara Vives, M. Dolores Moragues, Rosa Díaz, Silvia Tur, José Bernardo Escribano, César Lucas, Francisco Martínez, José Miguel Pons, Amparo Romero, David García, José Pérez, Ramón Villaverde, Salvadora Martínez, Aida Rodríguez, Carlos Tejero, Cristina Pérez, Enrique Mostacero, Covadonga Fernández, Alain Luna, Tomás Pérez, Félix González, Ana de Arce, Maite Martínez, Noemí Díez, Jaime Gállego, Beatriz Zandio, María Herrera, Nuria Aymerich, Roberto Muñoz, Javier Marta, Jorge Artal, José M. Errea, Juan José Timiraos, M. Pilar Moreno, Mar Freijo, Juan Manuel García, M. Carmen Gil, M. Ángeles Revilla, Enrique Palacio, José Luis Vázquez, María Bestué, Ana Latorre, Eva Calvo, Laura Ballester, Marta Serrano, Jesús M. Juega, M. Ángeles López, Pablo Irimia, Laura Imaz, Blanca Fuentes, Borja Enrique Sanz, Luis Beltrán, Gerardo Ruiz, Patricia Martínez, Demetrio Sánchez, Emilio Barroso, Igor Molina, Marco Antonio Budiño, Jaime Masjuan, Alicia de Felipe, Consuelo Matute, Javier Tejada, Alberto Morán, Esther Fernández, M. del Carmen Riveira, Joaquín Carnedo, Antonio Manquillo, Raquel González, José Carlos Fernández, Marta Guillan, Miguel Yebra, José M. Trejo, Jesús Saiz, Juan Carlos Martínez-Acitores, Yolanda Bravo, Juan Francisco Arenillas, Ana Calleja, Elisa Cortijo, Javier Reyes, Luis López, Pedro Luis Muñoz, M. Ángeles Fidalgo, Jacinto Hernández, José Carlos Gómez, José Carlos Morán, Sonia Gonzalo, Jorge Marrero, José Ángel Satué, Juan Carlos Belinchón, Francisco Moniche, Enrique Calderón, Irene Escudero, Javier de la Torre, Ignacio Casado, Joaquín Antón, Juan Carlos Portilla, Juan Luengo, Joan Rosal, Elena Calzado, Juan Carlos Anglada, Juan Girón, José M. Ramírez, Agustín Pijierro, Ana Roa, Jorge Romero, Mariano Aguayo, Cristina Borrachero, Gema Sanz, M. José Gómez, Miguel Ángel Rico, Antonio Cayon, Eduardo Carmona, Román Cerro, Rafael López, Alfonso Aguirre, Francisco Lozano, and José M. Rivera.

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business, Humanities
Abstract

Resumen Objetivo Identificar los factores asociados con el mal control de la anticoagulacion con antagonistas de la vitamina K (AVK) en pacientes con fibrilacion auricular no valvular (FANV) atendidos en consultas de Neurologia y Medicina Interna de Espana. Metodos Estudio transversal, multicentrico, anidado en el estudio ALADIN, de sujetos con FANV, tratados con AVK, atendidos en consultas de Medicina Interna o Neurologia de Espana. El grado de control de la anticoagulacion se estudio mediante el metodo directo y el de Rosendaal, considerando los 6 meses previos a la inclusion. Resultados De los 1.337 pacientes incluidos en ALADIN, 750 estaban tratados con AVK, con informacion completa sobre el INR de los ultimos 6 meses en 383 pacientes. Las puntuaciones medias del indice de Charlson, CHADS2, CHA2DS2-VASc y HAS-BLED fueron 1,94 ± 1,54; 3,10 ± 1,26; 4,63 ± 1,54 y 2,20 ± 0,90, respectivamente. El 46,2% y el 47,0% de los pacientes presentaban un control adecuado de la anticoagulacion por los metodos directo y Rosendaal, respectivamente. El control inadecuado de la anticoagulacion se asocio por el metodo directo con diabetes (OR: 2,511; IC 95%: 1,144-5,659), antecedentes de INR inestable (OR: 35,371; IC 95%: 15,058-83,083) y la realizacion de > 6 controles en los ultimos 6 meses (OR: 4,747; IC 95%: 2,094-10,759), y por el metodo de Rosendaal, con los antecedentes de INR inestable (p Conclusiones Pese al alto riesgo tromboembolico, solo estaban bien controlados algo mas de la mitad. Los factores asociados al mal control de la anticoagulacion fueron la diabetes, INR inestable, > 6 controles de INR y el HAS-BLED.

Published
2018
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10. Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

Author

Francisco Purroy, Francisco Moniche, María Alonso de Leciñana, Mar Castellanos, Óscar Ayo-Martín, Ana Morales, María Dolores Fernández Pérez, Esther Gallardo Corral, Patricia Martínez Sánchez, Juan Manuel Oropesa, Soledad Pérez Sánchez, Raul Espinosa Rosso, Jose Antonio Tamayo Toledo, Roberto Valverde Moyano, Carlos Tejero Juste, Herbert Tejada Meza, Elena López-Cancio Martínez, Ignacio Casado Menéndez, M Carmen Jimenez Martinez, Antonio Medina Rodriguez, Juan Carlos López Fernandez, Enrique Jesús Palacio Portilla, Juan Francisco Arenillas Lara, Javier Tejada García, Yolanda Bravo Anguiano, Marta Ferrero Ros, Jose C Segundo Rodriguez, Pere Cardona, Jaume Roquer González, Manuel Jesus Gómez-Choco Cuesta, Joan Marti Fabregas, Joaquín Serena Leal, Sergi Amaro Delgado, Jorge Pagola, Nicolas Lopez Hernandez, Alejandro Ponz De Tienda, Cristina Soriano Soriano, José Tembl Ferrairó, Ignacio Casado Naranjo, Jose M Ramirez Moreno, Jose Luis Maciñeiras Montero, Emilio Rodríguez Castro, Joaquin Carneado Ruiz, Patricia Calleja Castaño, Jose Antonio Egido Herrero, Andres Garcia Pastor, Alicia De Felipe Mimbrera, Araceli García Tejada, Marta Guillán Rodríguez, Laura Izquierdo Esteban, Beatriz Oyanguren Rodeño, Álvaro Ximénez-Carrillo Rico, Cristina Sánchez-Vizcaíno, María Herrera Isasi, Pablo Irimia Sieira, Mar Freijo Guerrero, Maite Martínez Zabaleta, and Juan Manuel García Sánchez

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Background and purpose Spain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact.Materials and methods We obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate.Results Fifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak’s peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established.Conclusion The COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.

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