TY - JOUR
T1 - Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19
T2 - CASCADE Initiative
AU - Sasanejad, Payam
AU - Afshar Hezarkhani, Leila
AU - Arsang-Jang, Shahram
AU - Tsivgoulis, Georgios
AU - Ghoreishi, Abdoreza
AU - Kristian, Barlinn
AU - Rahmig, Jan
AU - Farhoudi, Mehdi
AU - Sadeghi Hokmabadi, Elyar
AU - Borhani-Haghighi, Afshin
AU - Sariaslani, Payam
AU - Sharifi-Razavi, Athena
AU - Ghandehari, Kavian
AU - Khosravi, Alireza
AU - Smith, Craig
AU - Nilanont, Yongchai
AU - Akbari, Yama
AU - Nguyen, Thanh N.
AU - Bersano, Anna
AU - Yassi, Nawaf
AU - Yoshimoto, Takeshi
AU - Lattanzi, Simona
AU - Gupta, Animesh
AU - Zand, Ramin
AU - Rafie, Shahram
AU - Pourandokht Mousavian, Seyede
AU - Reza Shahsavaripour, Mohammad
AU - Amini, Shahram
AU - Kamenova, Saltanat U.
AU - Kondybayeva, Aida
AU - Zhanuzakov, Murat
AU - Macri, Elizabeth M.
AU - Nobleza, Christa O.Hana S.
AU - Ruland, Sean
AU - Cervantes-Arslanian, Anna M.
AU - Desai, Masoom J.
AU - Ranta, Annemarei
AU - Moghadam Ahmadi, Amir
AU - Rostamihosseinkhani, Mahtab
AU - Foroughi, Razieh
AU - Hooshmandi, Etrat
AU - Akhoundi, Fahimeh H.
AU - Shuaib, Ashfaq
AU - Liebeskind, David S.
AU - Siegler, James
AU - Romano, Jose G.
AU - Mayer, Stephan A.
AU - Bavarsad Shahripour, Reza
AU - Zamani, Babak
AU - Woolsey, Amadene
AU - Fazli, Yasaman
AU - Mojtaba, Khazaei
AU - Isaac, Christian F.
AU - Biller, Jose
AU - Di Napoli, Mario
AU - Azarpazhooh, M. Reza
N1 - Funding Information:
We would like to thank our patients and colleagues supporting us for this research despite all difficulties due to the pandemic.
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jstrokecerebrovasdis.2021.106121
DO - 10.1016/j.jstrokecerebrovasdis.2021.106121
M3 - Article
C2 - 34601242
AN - SCOPUS:85116060980
SN - 1052-3057
VL - 30
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 12
M1 - 106121
ER -