1. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.
- Author
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Sasanejad P, Afshar Hezarkhani L, Arsang-Jang S, Tsivgoulis G, Ghoreishi A, Barlinn K, Rahmig J, Farhoudi M, Sadeghi Hokmabadi E, Borhani-Haghighi A, Sariaslani P, Sharifi-Razavi A, Ghandehari K, Khosravi A, Smith C, Nilanont Y, Akbari Y, Nguyen TN, Bersano A, Yassi N, Yoshimoto T, Lattanzi S, Gupta A, Zand R, Rafie S, Pourandokht Mousavian S, Reza Shahsavaripour M, Amini S, Kamenova SU, Kondybayeva A, Zhanuzakov M, Macri EM, Nobleza COS, Ruland S, Cervantes-Arslanian AM, Desai MJ, Ranta A, Moghadam Ahmadi A, Rostamihosseinkhani M, Foroughi R, Hooshmandi E, Akhoundi FH, Shuaib A, Liebeskind DS, Siegler J, Romano JG, Mayer SA, Bavarsad Shahripour R, Zamani B, Woolsey A, Fazli Y, Mojtaba K, Isaac CF, Biller J, Di Napoli M, and Azarpazhooh MR
- Subjects
- Aged, Aged, 80 and over, COVID-19 diagnosis, COVID-19 mortality, Disability Evaluation, Europe, Female, Fibrinolytic Agents adverse effects, Hospital Mortality, Humans, Infusions, Intravenous, Intracranial Hemorrhages chemically induced, Iran, Ischemic Stroke complications, Ischemic Stroke diagnosis, Ischemic Stroke mortality, Male, Middle Aged, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, COVID-19 complications, Fibrinolytic Agents administration & dosage, Ischemic Stroke drug therapy, Thrombolytic Therapy adverse effects, Thrombolytic Therapy mortality
- Abstract
Background: There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19., Methods: This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes., Results: A total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054)., Conclusion: IV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19., Competing Interests: Declaration of Competing Interest Authors reports no disclosures., (Copyright © 2021. Published by Elsevier Inc.)
- Published
- 2021
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