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Updated: Dec 15, 2025

Prehospital Thrombolysis: A Manual from Berlin
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A single-centre experience of intravenous thrombolysis for stroke in COVID-19 patients

Davide Sangalli1, Valeria Polonia2,3, Daniele Colombo2

  • 1Unit of Neurology, "Alessandro Manzoni" Hospital - ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy. d.sangalli@asst-lecco.it.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|July 14, 2020
PubMed

Insights

Intravenous thrombolysis for acute ischemic stroke in COVID-19 patients presents significant risks. This study highlights unpredictable complications and high mortality, questioning the risk-benefit balance of rt-PA in these cases.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiovascular Medicine

Background:

  • The Coronavirus Disease 2019 (COVID-19) pandemic created unprecedented challenges in managing acute ischemic stroke.
  • The safety and efficacy of intravenous thrombolysis, particularly recombinant tissue plasminogen activator (rt-PA), in COVID-19 positive patients remain unclear.

Observation:

  • This study details four cases of acute ischemic stroke in patients with confirmed COVID-19 who underwent intravenous thrombolysis.
  • These patients exhibited unusual stroke features and experienced severe, unexpected complications post-treatment.

Findings:

  • The administration of rt-PA in acute ischemic stroke patients with COVID-19 was associated with a very high overall mortality rate.
  • The risk-benefit profile of intravenous thrombolysis in this specific patient population appears unfavorable due to unpredictable adverse events.

Implications:

  • These findings suggest a need for cautious consideration of intravenous thrombolysis in acute ischemic stroke patients who are also positive for COVID-19.
  • Further research is warranted to understand the pathophysiology and to establish optimal management strategies for acute ischemic stroke in the context of COVID-19 infection.

Keywords:
COVID-19Intravenous thrombolysisStrokert-PA

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