Decrease in intravenous thrombolysis and poor short-term functional prognosis for acute ischemic stroke during the COVID-19 pandemic

Xu, Xueqian; Xiao, Yuenan; Li, Jia; Chen, Liuzhu; Lin, Gangqiang; Dong, Ledan; Lin, Yisi; Zhan, Luqian; He, Jincai; Luan, Xiaoqian

doi:10.1007/s00415-021-10740-1

Cited by 6 publications

(12 citation statements)

References 21 publications

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“…More importantly, the time from the onset to arterial sheath insertion was observed to increase in February, March, April, June, and July 2020. This trend is consistent with our previous study on IVT during epidemics ( 23 ). The main reason may be the outbreak in recent months, Wenzhou's implementation of strict restrictions, affects and delays the green channel stroke.…”

Section: Discussionsupporting

confidence: 94%

Differential Influence of the COVID-19 Pandemic on Mechanical Thrombectomy and Bridging Therapy for Acute Ischemic Stroke

Geng

Luan

et al. 2022

Front. Neurol.

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is having a dramatic impact on acute stroke care. Its effects may accompany stroke care for a long time. We compared the treatment, short-term and long-term functional outcomes of patients with AIS from 2019 to 2020. Our objective was to evaluate the effect of COVID-19 epidemic on mechanical thrombectomy (MT) in patients in our hospital.MethodsWe collected information on subjects treated with MT in 2019–2020, including age, sex, time from the onset to arterial sheath insertion, time from the onset to recanalization, the rate of lung infection and hemorrhagic transformation, modified Rankin scale (mRS), NHISS, and ASPECTS.ResultsThe number of patients with MT decreased significantly by 26.6% in 2020 (p = 0.025). The pretreatment ASPECTS score for 2020 was significantly higher than 2019 (p = 0.004). Besides, the patients were more likely to develop lung infection (65 vs. 54.1%, p = 0.042) and had a higher risk of hemorrhagic transformation (47.4% vs. 30.4%, p = 0.005) in 2019. The discharged mRS reflected the worse short-term functional prognosis of patients with MT in 2019 (66 vs. 44.9%, p = 0.046). In the subgroup analysis of bridging thrombolysis (BT), more patients with BT are expected to have a poor short-term functional prognosis in 2020, according to the discharged mRS (62.5 vs. 37.5%, p = 0.024). However, there was no difference in mRS at 180 days between the two groups (p = 0.094).ConclusionFor patients with MT, both short- and long-term functional outcomes were not significantly affected due to the mild condition of patients admitted to hospital in 2020. For patients with BT, the COVID-19 pandemic has prolonged the green channel time of stroke, leading to a poor short-term functional prognosis of patients with stroke in the pandemic period. There was no difference in the effectiveness of direct MT and BT during the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 94%

Differential Influence of the COVID-19 Pandemic on Mechanical Thrombectomy and Bridging Therapy for Acute Ischemic Stroke

Geng

Luan

et al. 2022

Front. Neurol.

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“…Regarding the COVID-19 pandemic, there is a reasonable probability that we should cohabit with the virus, also in a more favorable endemic phase, but for a period of an actually unforeseeable duration; doubtless, the pre-COVID-19 dedicated paths need to be reinstated to guarantee guideline recommended stroke management [153, 181, 182]. Further studies are required for COVID-19 patients with AIS, both for the acute phase treatments and for their primary and secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, with COVID-19 lockdown many strokes occurred during isolation, and many of these patients arrived late, or never, to hospital for care [148]. In addition, access to time-dependent stroke therapies has been severely limited or delayed by a lack of transportation, emergency service overloads, disrespect for previous stroke paths, and a lack of CT availability [153][154][155][156][157].…”

Section: Stroke During Covid-19 Pandemicmentioning

confidence: 99%

Treatments in Ischemic Stroke: Current and Future

Mosconi¹,

Paciaroni²

2022

Eur Neurol

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Background and Aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of drugs with better safety-efficacy profiles as well as strategies able to improve ischemic stroke management from the pre-hospital setting is needed. Summary: The pathophysiology of ischemic stroke involves multiple pathways resulting in cerebral artery obstruction and brain tissue ischemia. To date, the only approved drug for acute ischemic stroke is intravenous thrombolytic alteplase. Intravenous thrombolysis (IVT) can be administered alone or in combination with endovascular treatment (EVT) with mechanical thrombectomy, in case of large vessel occlusion and generally within 6 h from symptoms onset. The risk of potential bleeding complications, especially symptomatic intracerebral hemorrhage, is one of the reasons for the reluctance to administer IVT. Tenecteplase is a promising alternative fibrinolytic agent, having a better safety profile than alteplase. Moreover, recent evidences have allowed an extension of the IVT ± EVT time window for patients with unknown onset time and for those with a known onset time thanks to the new “tissue-window” approach guided by advanced neuroimaging techniques, which also helps in collateral circulation estimation. Regarding primary-secondary prevention, researchers are focused on improving the efficacy of antithrombotic drugs with a “hemostasis-sparing” approach. Neuroprotective agents are also under development, particularly stem cells. The COVID-19 pandemic has critically stressed global healthcare systems, with collateral damage resulting in access delivery of only emergency care, such as ischemic stroke. Regarding telemedicine, it has had a minor role in acute stroke management, and with the onset of COVID-19, this role will most likely be adopted to increase access and delivery in stroke assessment, but also in the follow-up.

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“…Acute ischemic stroke (AIS) is the leading cause of death in China in 2017 (Wu et al., 2019) and its prevalence continues to increase (Tu et al., 2022), in which intravenous thrombolysis (IVT) still serves as the mainstream drug therapy. According to several recent studies, the COVID‐19 pandemic was associated with a global decline in the volume of stroke hospitalizations, intravenous thrombolysis (IVT), and interfacility IVT transfers (Velilla‐Alonso et al., 2021; Xu et al., 2022). It was believed that the pandemic mainly affected postadmission treatment procedures, where prolonged time of the green channel for stroke during the COVID‐19 pandemic was the leading cause (Xu et al., 2022).…”

Section: Introductionmentioning

confidence: 99%

Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic

et al. 2023

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Background: Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time-dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect.Methods: One hospital-based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset-to-door time (ODT) in the first 50%, while the door-to-needle time (DNT) was in the last quartile. DNT (in-hospital delay) was further subdivided into several time intervals [door-to-examination time (DET), doorto-imaging time (DIT), door-to-laboratory time (DLT), and decision-making time (DMT) of the patients or their proxies.Results: A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female.Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036-1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415-10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096-0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132-0.931; p = .035) were negatively associated with the deadline effect. Conclusions:A speed-safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID-19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.

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Decrease in intravenous thrombolysis and poor short-term functional prognosis for acute ischemic stroke during the COVID-19 pandemic

Cited by 6 publications

References 21 publications

Differential Influence of the COVID-19 Pandemic on Mechanical Thrombectomy and Bridging Therapy for Acute Ischemic Stroke

Differential Influence of the COVID-19 Pandemic on Mechanical Thrombectomy and Bridging Therapy for Acute Ischemic Stroke

Treatments in Ischemic Stroke: Current and Future

Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic

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