Background/Purpose: Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19.

Methods: We present a multicenter case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA.

Results: We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3–26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0–25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml).

Conclusions: IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.

背景/目的：2019 年冠状病毒病 (COVID-19) 与急性缺血性中风 (AIS) 风险增加相关，然而，关于静脉注射组织纤溶酶原激活剂 (IV tPA) 治疗中风患者后的结果的数据很少与新冠肺炎 (COVID-19) 相关。

方法：我们提出了来自美国 9 个中心的多中心病例系列，这些患者患有符合 AIS 和 COVID-19 的急性神经功能缺损，并接受了 IV tPA 治疗。

结果：我们确定了 13 名患者（平均年龄 62 (±9.8) 岁，9 名 (69.2%) 男性）。所有患者均接受静脉注射 tPA，其中 3 例还接受机械血栓切除术。所有患者入院时均出现与 COVID-19 一致的全身症状：发烧（5 名患者）、咳嗽（7 名患者）和呼吸困难（8 名患者）。入院 NIH 卒中量表 (NIHSS) 评分中位数为 14.5（范围 3-26），大多数患者 (61.5%) 在随访时有所改善（NIHSS 评分中位数 7.5，范围 0-25）。未发现全身性或症状性颅内出血。中风机制包括心源性栓塞（3名患者）、大动脉粥样硬化（2名患者）、小血管疾病（1名患者）、不明原因的栓塞性中风（3名患者）和未完全调查的隐源性中风（1名患者）。三名患者被确定患有短暂性脑缺血发作或中止中风。12 名患者中有 2 名 (16.6%) 患者入院时纤维蛋白原水平升高（平均 262.2 ± 87.5 mg/dl），11 名患者中有 7 名 (63.6%) 患者 D-二聚体水平升高（平均 4284.6 ±3368.9 ng/ml） ）。

结论：IV tPA 治疗 COVID-19 可能安全有效，但需要更大规模的研究来验证这些结果。