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

BACKGROUND: Comorbidity of acute ischemic stroke with Covid-19 is a challenging condition, potentially influencing the decision whether administering intravenous thrombolysis (IVT). We aimed to assess 1-month outcome in ischemic 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 a 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 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 mRS score 3-5. At 24-36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in 8 (17.4%) patients, symptomatic ICH (sICH) in 2 (4.3%) patients. Causes of death were severe ischemic stroke (n=8), a new ischemic 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 1-month mRS score 3-5, baseline glucose level was higher, while endovascular procedure time in case of bridging therapy was longer. Baseline NIHSS score baseline glucose level, and creatinine level were higher in patients who died.

CONCLUSIONS: IVT 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.