Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

Sasanejad P. Afshar Hezarkhani L. Arsang-Jang S. Tsivgoulis G. Ghoreishi A. Kristian B. 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 T.N. Bersano A. Yassi N. Yoshimoto T. Lattanzi S. Gupta A. Zand R. Rafie S. Pourandokht Mousavian S. Reza Shahsavaripour M. Amini S. Kamenova S.U. Kondybayeva A. Zhanuzakov M. Macri E.M. Nobleza C.O.S. Ruland S. Cervantes-Arslanian A.M. Desai M.J. Ranta A. Moghadam Ahmadi A. Rostamihosseinkhani M. Foroughi R. Hooshmandi E. Akhoundi F.H. Shuaib A. Liebeskind D.S. Siegler J. Romano J.G. Mayer S.A. Bavarsad Shahripour R. Zamani B. Woolsey A. Fazli Y. Mojtaba K. Isaac C.F. Biller J. Di Napoli M. Azarpazhooh M.R.
December 2021 W.B. Saunders

Journal of Stroke and Cerebrovascular Diseases
2021 #30 Issue 12

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.

COVID-19 , death , Disability , Longitudinal study , Outcomes , Safety , Stroke , Stroke severity , Thrombolytic therapy

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Department of Neurology Mashhad Fellowship of interventional radiology Mashhad University of Medical Sciences
Department of Neurology School of Medicine Farabi Hospital Kermanshah University of Medical Sciences, Kermanshah, Iran
Department of Biostatistics and Epidemiology School of Medicine Zanjan University of Medical Sciences, Zanjan, Iran
Second Department of Neurology National & Kapodistrian University of Athens, Professor of Neurology, Athens, Greece
Department of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences
University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Neurosciences Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Neurosciences Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Department of Neurology Mashhad University of Medical Sciences, Mashhad, Iran
Clinical Immunology Research Center, Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Salford, Manchester, United Kingdom
Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Departments of Neurology, Neurological Surgery, and Anatomy & Neurobiology, and Beckman Laser Institute & Medical Clinic, School of Medicine, University of California, Irvine, CA, United States
Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico carlo Besta, Milano, Italy
Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy
Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, Mexico
Department of Neurology, Neuroscience Institute, Geisinger Medical Center, Danville, PA, United States
Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Anesthesia, Intensive care Unit, Lung Research Center, Mashhad, Mashhad University of Medical Sciences
Department of Medicine, Al-Farabi Kazakh National University, Doctor of Medical Science, Almaty, Kazakhstan
Doctor of Medical Science, Professor Doctor of Medical Science, Professor, Department of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
Doctor of Medical Science Professor, Department of Internal Medicine, Kazakh-Russian Medical University, Almaty, Kazakhstan
Department of Neurology, University of New Mexico, Albuquerque, NM, United States
Department of Neurology, University of Mississippi Medical Center, Jackson, MS, United States
Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Chicago, IL, United States
Departments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
Assistant Professor of Neurology, University of New Mexico, Albuquerque
Department of Medicine, University of Otago, Wellington and Department of Neurology, Wellington Regional Hospital, New Zealand
Associate Professor of Neurology, School of Medicine, Non-communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Neurology, Iran University of medical Sciences, Tehran, Iran
Professor of Neurology and Director Stroke Program University of Alberta, AB, Canada
UCLA Stroke Center, Los Angeles, CA, United States
Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, United States
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
Professor of Neurology and Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY, United States
University of California San Diego Neurosciences center, Comprehensive Stroke center, San Diego, CA, United States
Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada. Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Assistant Professor of Neurology, Assistant Professor of Neurology, Hamadan Medical University of Medical Sciences, Fellowship of neurovascular intervention
Department of Neurology, Hospital Dr Arturo Oñativia, Argentina
Department of Neurology, Loyola University Health System, Stritch School of Medicine, Chicago, IL, United States
Department of Neurology and Stroke Unit, San Camillo de’ Lellis General District Hospital, Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, RietiSulmona, LAquila, Italy
Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada, Department of Clinical Neurological Sciences, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

Department of Neurology Mashhad Fellowship of interventional radiology Mashhad University of Medical Sciences
Department of Neurology School of Medicine Farabi Hospital Kermanshah University of Medical Sciences
Department of Biostatistics and Epidemiology School of Medicine Zanjan University of Medical Sciences
Second Department of Neurology National & Kapodistrian University of Athens
Department of Neurology
University Hospital Carl Gustav Carus
Department of Neurology
Neurosciences Research Center
Neurosciences Research Center
Clinical Neurology Research Center
Department of Neurology
Clinical Research Development Unit of Bou-Ali Sina Hospital
Department of Neurology Mashhad University of Medical Sciences
Clinical Immunology Research Center
Manchester Centre for Clinical Neurosciences
Siriraj Stroke Center
Departments of Neurology
Boston Medical Center
Cerebrovascular Unit
Department of Medicine and Neurology
Department of Neurology
Department of Experimental and Clinical Medicine
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Anesthesia
Department of Medicine
Doctor of Medical Science
Doctor of Medical Science Professor
Department of Neurology
Department of Neurology
Department of Neurology
Departments of Neurology
Assistant Professor of Neurology
Department of Medicine
Associate Professor of Neurology
Clinical Neurology Research Center
Clinical Neurology Research Center
Clinical Neurology Research Center
Department of Neurology
Professor of Neurology and Director Stroke Program University of Alberta
UCLA Stroke Center
Cooper Neurological Institute
Department of Neurology
Professor of Neurology and Neurosurgery
University of California San Diego Neurosciences center
Department of Neurology
Stroke Prevention and Atherosclerosis Research Centre
School of Medicine
Assistant Professor of Neurology
Department of Neurology
Department of Neurology
Department of Neurology and Stroke Unit
Stroke Prevention and Atherosclerosis Research Centre

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