Safety and outcomes of intravenous thrombolytic therapy in ischemic stroke patients with COVID-19: CASCADE initiative

Autor: Anna M. Cervantes-Arslanian, Mohammad Reza Shahsavaripour, Mahtab Rostamihosseinkhani, Elizabeth Macri, Mario Di Napoli, James E. Siegler, Amir Moghadam Ahmadi, José Biller, Christian F Isaac, Seyede Pourandokht Mousavian, Stephan A. Mayer, Saltanat Kamenova, Amadene Woolsey, Abdoreza Ghoreishi, Annemarei Ranta, Sean Ruland, Jan Rahmig, Shahram Amini, Yama Akbari, Craig J. Smith, Kavian Ghandehari, Athena Sharifi-Razavi, Alireza Khosravi, Jose G. Romano, Georgios Tsivgoulis, Christa O'Hana S. Nobleza, Elyar Sadeghi Hokmabadi, Takeshi Yoshimoto, Afshin Borhani-Haghighi, Anna Bersano, Shahram Arsang-Jang, Fahimeh Haji Akhoundi, Simona Lattanzi, Murat Zhanuzakov, Barlinn Kristian, Leila Afshar Hezarkhani, Nawaf Yassi, Payam Sasanejad, Ashfaq Shuaib, Masoom Desai, Payam Sariaslani, Yasaman Fazli, Reza Bavarsad Shahripour, Shahram Rafie, Mehdi Farhoudi, Babak Zamani, Khazaei Mojtaba, Ramin Zand, Thanh N. Nguyen, Razieh Foroughi, David S Liebeskind, Animesh Gupta, Aida Kondybayeva, Yongchai Nilanont, Etrat Hooshmandi, M. Reza Azarpazhooh
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Longitudinal study
Time Factors
Iran
outcomes
Disability Evaluation
Modified Rankin Scale
Risk Factors
80 and over
Thrombolytic Therapy
Hospital Mortality
Infusions
Intravenous
Stroke
thrombolytic therapy
Aged
80 and over
Rehabilitation
Confounding
longitudinal study
stroke severity
Middle Aged
Europe
Stroke severity
Treatment Outcome
Cohort
Female
Safety
Cardiology and Cardiovascular Medicine
Intravenous
Intracranial Hemorrhages
COVID 19
safety
medicine.medical_specialty
Infusions
Coronavirus disease 2019 (COVID-19)
Clinical Sciences
Outcomes
Risk Assessment
Article
Fibrinolytic Agents
Clinical Research
Internal medicine
death
medicine
Humans
Aged
Ischemic Stroke
Disability
Neurology & Neurosurgery
business.industry
Neurosciences
COVID-19
Odds ratio
medicine.disease
Brain Disorders
Good Health and Well Being
disability
Ischemic stroke
Surgery
Neurology (clinical)
business
Zdroj: Journal of Stroke and Cerebrovascular Diseases
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, vol 30, iss 12
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, R, Zamani, B, Woolsey, A, Fazli, Y, Mojtaba, K, Isaac, C F, Biller, J, Di Napoli, M & Azarpazhooh, M R 2021, ' Safety and outcomes of intravenous thrombolytic therapy in ischemic stroke patients with COVID-19: CASCADE initiative ', Journal of Stroke and Cerebrovascular Diseases . https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106121
ISSN: 1532-8511
1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106121
Popis: BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis 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.ResultsA 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).ConclusionIV-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.
Databáze: OpenAIRE
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