Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;27(12):2641-2645.
doi: 10.1111/ene.14511. Epub 2020 Oct 15.

Thrombolysis and bridging therapy in patients with acute ischaemic stroke and Covid-19

M Cappellari  1 , A Zini  2 , D Sangalli  3 , A Cavallini  4 , M Reggiani  5 , F N Sepe  6 , N Rifino  7 , G Giussani  8 , D Guidetti  9 , M Zedde  10 , S Marcheselli  11 , M Longoni  12 , S Beretta  13 , V Sidoti  14 , D M Papurello  15 , A Giossi  16 , P Nencini  17 , M Plocco  18 , M Balestrino  19 , E Rota  20 , D Toni  21
Affiliations

Thrombolysis and bridging therapy in patients with acute ischaemic stroke and Covid-19

M Cappellari et al. Eur J Neurol. 2020 Dec.

Abstract

Background and purpose: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy).

Methods: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT.

Results: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died.

Conclusions: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.

Keywords: Covid-19; bridging therapy; outcome; stroke; thrombolysis.

PubMed Disclaimer

References

    1. Beyrouti R, Adams ME, Benjamin L, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020; 91: 889-891.
    1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513.
    1. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77: 683.
    1. Yaghi S, Ishida K, Torres J, et al. SARS2-CoV-2 and stroke in a New York healthcare system. Stroke 2020; 51: 2002-2011.
    1. Escalard S, Maïer B, Redjem H, et al. Treatment of acute ischemic stroke due to large vessel occlusion with COVID-19. Stroke 2020; 51: 2540-2543.

MeSH terms