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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19
Thiago Carneiro1, Jonathan Dashkoff1, Lester Y Leung2
1Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Collamore C3 Neurology, Boston, MA 02118, United States.
Insights
Intravenous tissue plasminogen activator (IV tPA) appears safe for treating acute ischemic stroke (AIS) in COVID-19 patients. Most patients showed improvement, with no major hemorrhages observed, suggesting potential efficacy.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiovascular Medicine
Background:
- COVID-19 infection is linked to a higher risk of acute ischemic stroke (AIS).
- Limited data exists on the outcomes of IV tPA treatment for AIS in patients with COVID-19.
Purpose of the Study:
- To evaluate the safety and efficacy of intravenous tissue plasminogen activator (IV tPA) in patients with acute ischemic stroke (AIS) and COVID-19.
Main Methods:
- A multicenter case series involving 9 US centers.
- Included patients presented with acute neurological deficits consistent with AIS and had confirmed COVID-19.
- Treatment administered was IV tPA, with some patients also receiving mechanical thrombectomy.
Main Results:
- 13 patients (mean age 62, 69.2% male) were identified.
- Most patients (61.5%) improved following IV tPA treatment, with a median NIHSS score reduction.
- No instances of systemic or symptomatic intracranial hemorrhage were reported.
Conclusions:
- IV tPA may be a safe and effective treatment option for acute ischemic stroke in patients with COVID-19.
- Larger-scale studies are necessary to confirm these preliminary findings and validate the treatment's efficacy.
Background/Purpose:
Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19.
Methods:
We present a multicenter case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA.
Results:
We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3-26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0-25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml).
Conclusions:
IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.
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