Payam SasanejadLeila Afshar HezarkhaniShahram Arsang-JangGeorgios TsivgoulisAbdoreza GhoreishiBarlinn KristianJan RahmigMehdi FarhoudiElyar Sadeghi HokmabadiAfshin Borhani-HaghighiPayam SariaslaniAthena Sharifi-RazaviKavian GhandehariAlireza KhosraviCraig SmithYongchai NilanontYama AkbariThanh N. NguyenAnna BersanoNawaf YassiTakeshi YoshimotoSimona LattanziAnimesh GuptaRamin ZandShahram RafieSeyede Pourandokht MousavianMohammad Reza ShahsavaripourShahram AminiSaltanat U. KamenovaAida KondybayevaMurat ZhanuzakovElizabeth M. MacriChrista O.Hana S. NoblezaSean RulandAnna M. Cervantes-ArslanianMasoom J. DesaiAnnemarei RantaAmir Moghadam AhmadiMahtab RostamihosseinkhaniRazieh ForoughiEtrat HooshmandiFahimeh H. AkhoundiAshfaq ShuaibDavid S. LiebeskindJames SieglerJose G. RomanoStephan A. MayerReza Bavarsad ShahripourBabak ZamaniAmadene WoolseyYasaman FazliKhazaei MojtabaChristian F. IsaacJose BillerMario Di NapoliM. Reza AzarpazhoohKazakh Russian Medical UniversityUniversitätsklinikum Carl Gustav Carus DresdenSiriraj HospitalVali-e-Asr Hospital, Zanjan University of Medical Sciences (ZUMS)Clinical Neurology Research CenterClinical Immunology Research Center (ZAUMS)Neurosciences Research CenterAl Farabi Kazakh National UniversityThe University of New MexicoUNM School of MedicineUniversità Politecnica delle MarcheUniversity of AlbertaUniversity of California, San DiegoRobarts Research InstituteLoyola University Stritch School of MedicineSchool of Medicine, Kermanshah University of Medical SciencesEthnikó ke Kapodistriakó Panepistímio AthinónWestchester Medical CenterUniversity of MelbourneAhvaz Jundishapur University of Medical SciencesIran University of Medical SciencesUniversity of Miami Leonard M. Miller School of MedicineMazandaran University of Medical SciencesCooper University HospitalUniversity of OtagoFoundation IRCCS Neurological Institute "C. Besta"Loyola University Health SystemNational Cerebral and Cardiovascular CenterRafsanjan University of Medical SciencesZanjan University of Medical Sciences (ZUMS)UCI Beckman Laser Institute & Medical ClinicKermanshah University of Medical SciencesHamadan University of Medical SciencesDavid Geffen School of Medicine at UCLAUniversity of Mississippi Medical CenterThe University of ManchesterBoston Medical CenterMashhad University of Medical Sciences, School of MedicineGeisinger Medical CenterMashhad University of Medical SciencesHospital Dr Arturo OñativiaSan Camillo de’ Lellis General District Hospital2022-08-042022-08-042021-12-01Journal of Stroke and Cerebrovascular Diseases. Vol.30, No.12 (2021)15328511105230572-s2.0-85116060980https://repository.li.mahidol.ac.th/handle/20.500.14594/77518Background: 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.Mahidol UniversityMedicineArticleSCOPUS10.1016/j.jstrokecerebrovasdis.2021.106121