Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative,Journal of Stroke & Cerebrovascular Diseases

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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

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.
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, Salford, UK; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
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, USA.
Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
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, USA.
Department of Neurology, Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA.
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 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, Professor. 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.
Department of Neurology, University of Mississippi Medical Center, Jackson, MS.
Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Chicago, IL.
Departments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston University School of Medicine, Boston Medical Center, Boston, MA.
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.
Department of Neurology, Iran University of medical Sciences, Tehran, Iran.
Professor of Neurology and Director Stroke Program University of Alberta, Alberta, Canada.
UCLA Stroke Center, Los Angeles, CA, USA.
Cooper Neurological Institute, Cooper University Hospital, Camden, NJ.
Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Professor of Neurology and Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
University of California San Diego Neurosciences center, Comprehensive Stroke center, San Diego, CA.
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, Ontario, 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, USA.
Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, 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, Ontario, Canada.

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 )。