Systemic thrombolysis in ischaemic stroke patients with COVID‐19

• Published in: Acta neurologica Scandinavica Vol. 145; no. 1; pp. 47 - 52
• Main Authors: Sobolewski, Piotr, Antecki, Jacek, Brola, Waldemar, Fudala, Małgorzata, Bieniaszewski, Leszek, Kozera, Grzegorz
• Format: Journal Article
• Language: English
• Published: Denmark John Wiley & Sons, Inc 01.01.2022; John Wiley and Sons Inc
• Subjects: Brain Ischemia - complications; Brain Ischemia - drug therapy; COVID-19; Fibrinolytic Agents - therapeutic use; functional outcome; Humans; Infections; Intravenous administration; intravenous thrombolysis; ischaemic stroke; Ischemia; Ischemic Stroke; Multivariate analysis; Original; Patients; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Stroke; Stroke - complications; Stroke - drug therapy; t-Plasminogen activator; Thrombolysis; Thrombolytic drugs; Thrombolytic Therapy; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; COVID-19; ischaemic stroke; functional outcome; intravenous thrombolysis
• ISSN: 0001-6314; 1600-0404; 1600-0404
• DOI: 10.1111/ane.13520

Objective Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID‐19 infection negatively modifies acute stroke procedures and, due to its pro‐coagulative effect, may potentially impact on IVT outcome. Thus, short‐term efficacy and safety of IVT were compared in patients with and without evidence of SARS‐CoV‐2. Methods An observational, retrospective study included 70 patients with AIS, including 22 subjects (31%) with evidence of acute COVID‐19 infection, consecutively treated with IVT in 4 stroke centres between 15 September and 30 November 2020. Results Patients infected with COVID‐19 were characterized by higher median of National Institute of Health Stroke Scale (NIHSS) score (11.0 vs. 6.5; p < .01) and D‐dimers (870 vs. 570; p = .03) on admission, higher presence of pneumonia (47.8% vs. 12%; p < .01) and lower percentage of ‘minor stroke symptoms’ (NIHSS 1–5 pts.) (2% vs., 18%; p < .01). Hospitalizations were longer in patients with COVID‐19 than in those without it (17 vs. 9 days, p < .01), but impact of COVID‐19 infection on patients’ in‐hospital mortality or functional status on dismission has been confirmed neither in uni‐ or multivariate analysis. Conclusion SARS‐CoV‐2 infection prolongs length of stay in hospital after IVT, but does not influence in‐hospital outcome.