当前位置: X-MOL 学术J. Stroke Cerebrovasc. Dis. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative
Journal of Stroke & Cerebrovascular Diseases ( IF 2.0 ) Pub Date : 2021-09-20 , DOI: 10.1016/j.jstrokecerebrovasdis.2021.106121
Payam Sasanejad 1 , Leila Afshar Hezarkhani 2 , Shahram Arsang-Jang 3 , Georgios Tsivgoulis 4 , Abdoreza Ghoreishi 5 , Kristian Barlinn 6 , Jan Rahmig 7 , Mehdi Farhoudi 8 , Elyar Sadeghi Hokmabadi 9 , Afshin Borhani-Haghighi 10 , Payam Sariaslani 11 , Athena Sharifi-Razavi 12 , Kavian Ghandehari 13 , Alireza Khosravi 14 , Craig Smith 15 , Yongchai Nilanont 16 , Yama Akbari 17 , Thanh N Nguyen 18 , Anna Bersano 19 , Nawaf Yassi 20 , Takeshi Yoshimoto 21 , Simona Lattanzi 22 , Animesh Gupta 23 , Ramin Zand 24 , Shahram Rafie 25 , Seyede Pourandokht Mousavian 26 , Mohammad Reza Shahsavaripour 26 , Shahram Amini 27 , Saltanat U Kamenova 28 , Aida Kondybayeva 29 , Murat Zhanuzakov 30 , Elizabeth M Macri 31 , Christa O'Hana S Nobleza 32 , Sean Ruland 33 , Anna M Cervantes-Arslanian 34 , Masoom J Desai 35 , Annemarei Ranta 36 , Amir Moghadam Ahmadi 37 , Mahtab Rostamihosseinkhani 10 , Razieh Foroughi 10 , Etrat Hooshmandi 10 , Fahimeh H Akhoundi 38 , Ashfaq Shuaib 39 , David S Liebeskind 40 , James Siegler 41 , Jose G Romano 42 , Stephan A Mayer 43 , Reza Bavarsad Shahripour 44 , Babak Zamani 45 , Amadene Woolsey 46 , Yasaman Fazli 47 , Khazaei Mojtaba 48 , Christian F Isaac 49 , Jose Biller 50 , Mario Di Napoli 51 , M Reza Azarpazhooh 52
Affiliation  

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.



中文翻译:


COVID-19 缺血性脑卒中患者静脉溶栓治疗的安全性和结果:CASCADE Initiative


 背景


关于静脉注射组织纤溶酶原激活剂 (IV-tPA) 在中风和 COVID-19 患者中的安全性的信息很少。

 方法


这项多中心研究包括 2019 年 2 月 18 日至 2020 年 12 月 31 日期间在参与 CASCADE 计划的 9 个中心连续接受 IV-tPA 治疗的患有和不患有 COVID-19 的中风患者。临床结果包括出院时改良Rankin量表(mRS)、院内死亡率、出血转化率。使用贝叶斯多元回归,并在对单变量分析中具有显着值的变量进行调整后,我们报告了主要结果的后验调整优势比(OR,可信区间为 95% [CrI])。

 结果


共有 545 名中风患者接受了评估,其中包括 101 名 COVID-19 患者。 COVID-19 患者入院时有更严重的中风。在研究队列中,85 名患者(15.9%)发生出血性转化,72 名患者(13.1%)在医院死亡。调整混杂变量后,出院 mRS 评分≥2(OR:0.73,95% CrI:0.16,3.05),院内死亡率(OR:2.06,95% CrI:0.76,5.53)和出血转化(OR:1.514) ,95% CrI:0.66,3.31)在 COVID-19 和非 COVID-19 患者中相似。高敏 C 反应蛋白水平是所有病例出血性转化的预测因子 (OR:1.01, 95%CI: 1.0026, 1.018),包括那些患有 COVID-19 的病例 (OR:1.024, 95%CI: 1.002, 1.054 )。

 结论


与未患 COVID-19 的患者相比,患有急性缺血性卒中并患有 COVID-19 的患者接受 IV-tPA 治疗与残疾、死亡和出血性转化风险增加无关。 IV-tPA 应继续被视为超急性卒中和 COVID-19 患者的标准治疗。

更新日期:2021-09-30
down
wechat
bug