Publication:
Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

Issued Date

2021-12-01

Resource Type

Article

ISSN

15328511
10523057

DOI

10.1016/j.jstrokecerebrovasdis.2021.106121

Other identifier(s)

2-s2.0-85116060980

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of Stroke and Cerebrovascular Diseases. Vol.30, No.12 (2021)

Suggested Citation

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. Journal of Stroke and Cerebrovascular Diseases. Vol.30, No.12 (2021). doi:10.1016/j.jstrokecerebrovasdis.2021.106121 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77518

Research Projects

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Thesis

Title

Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

Author(s)

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

Other Contributor(s)

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

Abstract

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77518

Collections

Scopus 2021