Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

Abstract

<jats:sec><jats:title>Background and purpose</jats:title><jats:p> On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection. </jats:p></jats:sec>

Impact of COVID-19 on Hospital Admission of Acute Stroke patients in Bangladesh

“…With the report of several cases of large vessel occlusion from New York and taking the pathogenic mechanism of neurologic syndromes in COVID-19 patients into consideration, the number of acute stroke cases in Bangladesh was expected to show a steep rise during the pandemic 2,[7][8][9][10] . In contrary to the forecast, our analysis based on number of admitted stroke cases in the largest stroke treatment center of the country over the period of January to June, 2020 revealed a gross (46.3%) reduction in the rate of acute stroke admissions in last three months of the study period when the infection surged.…”

“…Some researchers had stated that the viral affinity to ACE-2 receptor present in endothelium might be responsible for the rupture of intracranial vessel wall 9 . COVID-19-related stroke patients were more likely to be older, hypertensive, and had a higher D-dimer level 10 . Qin C et all 11 reported that COVID-19 related stroke patients had more comorbidity, lower platelet counts and leukocyte counts, and the patients had higher levels of D-dimers, cardiac troponin I, NT pro-brain natriuretic peptide, and interleukin-6.…”

COVID-19: Famotidine, Histamine, Mast Cells, and Mechanisms

“…In the out-patient setting, early COVID-19 is usually indistinguishable from other "in uenza-like illnesses", presenting with various non-speci c symptoms ranging from sore throat, headache and diarrhea to fever, cough, and myalgias. In these rst few days however, COVID-2 may also be associated with anosmia, a unique feature 64 Patients may also present with additional neurological symptoms and complications including ischemic stroke [67][68][69] . Cardiac complications of later COVID-19 include myocarditis, acute myocardial infarction, heart failure, dysrhythmias, and venous thromboembolic events 70,71 .…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…Various international and Indian guidelines have advocated thrombolytic therapy in COVID-19 suspect/positive patients with acute ischemic stroke. [129][130][131] There have been concerns surrounding disseminated intravascular coagulation in COVID-19 and the risks of excessive bleeding in these patients. However, COVID-19induced coagulopathy (CIC) appears to be more prothrombotic than hemorrhagic.…”