Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative
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 Dec...
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Medicine Payam Sasanejad Leila Afshar Hezarkhani Shahram Arsang-Jang Georgios Tsivgoulis Abdoreza Ghoreishi Barlinn Kristian Jan Rahmig Mehdi Farhoudi Elyar Sadeghi Hokmabadi Afshin Borhani-Haghighi Payam Sariaslani Athena Sharifi-Razavi Kavian Ghandehari Alireza Khosravi Craig Smith Yongchai Nilanont Yama Akbari Thanh N. Nguyen Anna Bersano Nawaf Yassi Takeshi Yoshimoto Simona Lattanzi Animesh Gupta Ramin Zand Shahram Rafie Seyede Pourandokht Mousavian Mohammad Reza Shahsavaripour Shahram Amini Saltanat U. Kamenova Aida Kondybayeva Murat Zhanuzakov Elizabeth M. Macri Christa O.Hana S. Nobleza Sean Ruland Anna M. Cervantes-Arslanian Masoom J. Desai Annemarei Ranta Amir Moghadam Ahmadi Mahtab Rostamihosseinkhani Razieh Foroughi Etrat Hooshmandi Fahimeh H. Akhoundi Ashfaq Shuaib David S. Liebeskind James Siegler Jose G. Romano Stephan A. Mayer Reza Bavarsad Shahripour Babak Zamani Amadene Woolsey Yasaman Fazli Khazaei Mojtaba Christian F. Isaac Jose Biller Mario Di Napoli M. Reza Azarpazhooh Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative |
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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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Kazakh Russian Medical University |
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Kazakh Russian Medical University Payam Sasanejad Leila Afshar Hezarkhani Shahram Arsang-Jang Georgios Tsivgoulis Abdoreza Ghoreishi Barlinn Kristian Jan Rahmig Mehdi Farhoudi Elyar Sadeghi Hokmabadi Afshin Borhani-Haghighi Payam Sariaslani Athena Sharifi-Razavi Kavian Ghandehari Alireza Khosravi Craig Smith Yongchai Nilanont Yama Akbari Thanh N. Nguyen Anna Bersano Nawaf Yassi Takeshi Yoshimoto Simona Lattanzi Animesh Gupta Ramin Zand Shahram Rafie Seyede Pourandokht Mousavian Mohammad Reza Shahsavaripour Shahram Amini Saltanat U. Kamenova Aida Kondybayeva Murat Zhanuzakov Elizabeth M. Macri Christa O.Hana S. Nobleza Sean Ruland Anna M. Cervantes-Arslanian Masoom J. Desai Annemarei Ranta Amir Moghadam Ahmadi Mahtab Rostamihosseinkhani Razieh Foroughi Etrat Hooshmandi Fahimeh H. Akhoundi Ashfaq Shuaib David S. Liebeskind James Siegler Jose G. Romano Stephan A. Mayer Reza Bavarsad Shahripour Babak Zamani Amadene Woolsey Yasaman Fazli Khazaei Mojtaba Christian F. Isaac Jose Biller Mario Di Napoli M. Reza Azarpazhooh |
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Payam Sasanejad Leila Afshar Hezarkhani Shahram Arsang-Jang Georgios Tsivgoulis Abdoreza Ghoreishi Barlinn Kristian Jan Rahmig Mehdi Farhoudi Elyar Sadeghi Hokmabadi Afshin Borhani-Haghighi Payam Sariaslani Athena Sharifi-Razavi Kavian Ghandehari Alireza Khosravi Craig Smith Yongchai Nilanont Yama Akbari Thanh N. Nguyen Anna Bersano Nawaf Yassi Takeshi Yoshimoto Simona Lattanzi Animesh Gupta Ramin Zand Shahram Rafie Seyede Pourandokht Mousavian Mohammad Reza Shahsavaripour Shahram Amini Saltanat U. Kamenova Aida Kondybayeva Murat Zhanuzakov Elizabeth M. Macri Christa O.Hana S. Nobleza Sean Ruland Anna M. Cervantes-Arslanian Masoom J. Desai Annemarei Ranta Amir Moghadam Ahmadi Mahtab Rostamihosseinkhani Razieh Foroughi Etrat Hooshmandi Fahimeh H. Akhoundi Ashfaq Shuaib David S. Liebeskind James Siegler Jose G. Romano Stephan A. Mayer Reza Bavarsad Shahripour Babak Zamani Amadene Woolsey Yasaman Fazli Khazaei Mojtaba Christian F. Isaac Jose Biller Mario Di Napoli M. Reza Azarpazhooh |
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Payam Sasanejad |
title |
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative |
title_short |
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative |
title_full |
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative |
title_fullStr |
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative |
title_full_unstemmed |
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative |
title_sort |
safety and outcomes of intravenous thrombolytic therapy in ischemic stroke patients with covid-19: cascade initiative |
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2022 |
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https://repository.li.mahidol.ac.th/handle/123456789/77518 |
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th-mahidol.775182022-08-04T16:01:38Z Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative Payam Sasanejad Leila Afshar Hezarkhani Shahram Arsang-Jang Georgios Tsivgoulis Abdoreza Ghoreishi Barlinn Kristian Jan Rahmig Mehdi Farhoudi Elyar Sadeghi Hokmabadi Afshin Borhani-Haghighi Payam Sariaslani Athena Sharifi-Razavi Kavian Ghandehari Alireza Khosravi Craig Smith Yongchai Nilanont Yama Akbari Thanh N. Nguyen Anna Bersano Nawaf Yassi Takeshi Yoshimoto Simona Lattanzi Animesh Gupta Ramin Zand Shahram Rafie Seyede Pourandokht Mousavian Mohammad Reza Shahsavaripour Shahram Amini Saltanat U. Kamenova Aida Kondybayeva Murat Zhanuzakov Elizabeth M. Macri Christa O.Hana S. Nobleza Sean Ruland Anna M. Cervantes-Arslanian Masoom J. Desai Annemarei Ranta Amir Moghadam Ahmadi Mahtab Rostamihosseinkhani Razieh Foroughi Etrat Hooshmandi Fahimeh H. Akhoundi Ashfaq Shuaib David S. Liebeskind James Siegler Jose G. Romano Stephan A. Mayer Reza Bavarsad Shahripour Babak Zamani Amadene Woolsey Yasaman Fazli Khazaei Mojtaba Christian F. Isaac Jose Biller Mario Di Napoli M. Reza Azarpazhooh Kazakh Russian Medical University Universitätsklinikum Carl Gustav Carus Dresden Siriraj Hospital Vali-e-Asr Hospital, Zanjan University of Medical Sciences (ZUMS) Clinical Neurology Research Center Clinical Immunology Research Center (ZAUMS) Neurosciences Research Center Al Farabi Kazakh National University The University of New Mexico UNM School of Medicine Università Politecnica delle Marche University of Alberta University of California, San Diego Robarts Research Institute Loyola University Stritch School of Medicine School of Medicine, Kermanshah University of Medical Sciences Ethnikó ke Kapodistriakó Panepistímio Athinón Westchester Medical Center University of Melbourne Ahvaz Jundishapur University of Medical Sciences Iran University of Medical Sciences University of Miami Leonard M. Miller School of Medicine Mazandaran University of Medical Sciences Cooper University Hospital University of Otago Foundation IRCCS Neurological Institute "C. Besta" Loyola University Health System National Cerebral and Cardiovascular Center Rafsanjan University of Medical Sciences Zanjan University of Medical Sciences (ZUMS) UCI Beckman Laser Institute & Medical Clinic Kermanshah University of Medical Sciences Hamadan University of Medical Sciences David Geffen School of Medicine at UCLA University of Mississippi Medical Center The University of Manchester Boston Medical Center Mashhad University of Medical Sciences, School of Medicine Geisinger Medical Center Mashhad University of Medical Sciences Hospital Dr Arturo Oñativia San Camillo de’ Lellis General District Hospital Medicine 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. 2022-08-04T09:01:38Z 2022-08-04T09:01:38Z 2021-12-01 Article Journal of Stroke and Cerebrovascular Diseases. Vol.30, No.12 (2021) 10.1016/j.jstrokecerebrovasdis.2021.106121 15328511 10523057 2-s2.0-85116060980 https://repository.li.mahidol.ac.th/handle/123456789/77518 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85116060980&origin=inward |