Recombinant tissue plasminogen activator (rTPA) management for first onset acute ischemic stroke with covid -19 and non-covid -19 patients

Khedr, Eman M.; Abdel-Warith, Abdel-Wahab A.; Moussa, Gehad M; Saber, Mostafa

doi:10.1016/j.jstrokecerebrovasdis.2023.107031

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…Participants were evaluated at multiple time points using the National Institutes of Health Stroke Scale (NIHSS) and the modi ed Rankin scale (mRS) The Both NIHSS and mRS scales were measured at baseline (pre-treatment) and immediately post-treatment. The NIHSS was additionally assessed one week after treatment, while both scales were evaluated again at three months post-treatment, as indicated in another study [25].…”

Section: Methodsmentioning

confidence: 99%

The Impact of Sex Differences on Stroke Risk Factors and 3-Month Outcomes in Patients Receiving Thrombolytic Therapy for Acute Ischemic Stroke

Khedr,

Abo-Elfetoh,

Hasan

et al. 2024

Preprint

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Background: Acute ischemic stroke (AIS) is a major public health issue, and women have a disproportionate share of stroke-related disability and mortality, which is poorly understood. This study aimed to determine the effect of sex differences on AIS treated by thrombolysis using recombinant tissue plasminogen activator (rTPA). The study included 134 AIS patients (59% males and 41% females). Risk factors, clinical presentation, thrombolysis response, complications, and outcomes were recorded. The outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) three months after stroke. The incidence of intracranial haemorrhage was also determined. Results: Among 134 AIS patients treated with rTPA (59% male, 41% female), females had higher rates of hypertension (67.3% vs 49.4%, p=0.040) and atrial fibrillation (AF) (12.7% vs 2.5%, p=0.020), while smoking was more prevalent in males (31.6% vs 0%, p<0.0001). Cardioembolism was more frequent in females (23.6% vs 6.3%, p=0.004), who also had shorter onset-to-door (110.7±63 vs 131.1±50.2 min, p=0.035) and onset-to-needle times (151.6±66.5 vs 173.7±50.6 min, p=0.046). Both sexes showed significant improvements in NIHSS (males: 11.58±3.7 to 6.05±5.6; females: 11.64±4.7 to 6.9±5.9; p<0.0001) and mRS scores (males: 3.34±1.05 to 2.03±2; females: 3.53±1 to 2.02±2; p<0.0001) over three months, with no significant differences between sexes. Predictors of poor outcome (mRS 3-6) differed: diabetes millites (DM) (OR 7.79, p=0.002) and longer door-to-needle time (OR 1.04, p=0.008) for males, and hemorrhage (OR 9.41, p=0.048) for females. Hemorrhage predicted mortality in males (OR 27.08, p<0.0001), while AF was associated with increased mortality in females (OR 8.06, p=0.024). Conclusions: This study revealed sex-specific differences in AIS risk factors, etiology, and rTPA treatment timelines, although post-treatment improvements were comparable between sexes. Notably, outcome predictors and mortality factors differed by sex. These findings emphasize the need for sex-specific considerations in AIS management and risk assessment.

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Section: Methodsmentioning

confidence: 99%

The Impact of Sex Differences on Stroke Risk Factors and 3-Month Outcomes in Patients Receiving Thrombolytic Therapy for Acute Ischemic Stroke

Khedr,

Abo-Elfetoh,

Hasan

et al. 2024

Preprint

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“…Additionally, the COVID-19 patients displayed a higher susceptibility to hemorrhagic transformation. They considered that the high hemorrhagic transformation rate after intravenous thrombolytic therapy in COVID-19 patients may be related to the concomitant endothelial injury, large infarct size, high National Institutes of Health Stroke Scale (NIHSS) score, hyperglycemia on admission, and multiple other co-morbidities of COVID-19 ( 92 ). Despite the high incidence of hemorrhagic transformation, t-PA remains the cornerstone of treatment for AIS with or without COVID-19 infection, and therefore COVID-19 patients should be closely monitored after receiving intravenous thrombolysis.…”

Section: Acute Stroke Treatment During the Covid-19 Pandemicmentioning

confidence: 99%

Coronavirus disease 2019 and acute cerebrovascular events: a comprehensive overview

Zhang

Liu

et al. 2023

Front. Neurol.

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Since the Corona Virus Disease 2019 (COVID-19) pandemic, there has been increasing evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with acute cerebrovascular events such as cerebral infarction, cerebral hemorrhage, and cerebral venous thrombosis. Although the mechanism of cerebrovascular complications among COVID-19 patients has not been adequately elucidated, the hypercoagulable state, excessive inflammation and ACE-2-associated alterations in the renin-angiotensin-aldosterone system after SARS-CoV-2 infection probably play an essential role. In this overview, we discuss the possible mechanisms underlying the SARS-CoV-2 infection leading to acute cerebrovascular events and review the characteristics of COVID-19-related acute cerebrovascular events cases and treatment options available worldwide.

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“…To give examples of some articles that examine the relationship between COVID-19 and stroke biologically, Khedr et al [28] compared the efficacy and safety of tissue plasminogen activator (rTPA) in acute ischemic stroke (AIS) patients with or without COVID-19 infection. Massoud et al [29] showed that the risk of stroke appears significant in the first week following infection with COVID-19 but drops to insignificance two weeks later.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Side Effects: A Mathematical Modeling of COVID-19 and Stroke with Real Data

Özköse

2023

Fractal Fract

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The post-effects of COVID-19 have begun to emerge in the long term in society. Stroke has become one of the most common side effects in the post-COVID community. In this study, to examine the relationship between COVID-19 and stroke, a fractional-order mathematical model has been constructed by considering the fear effect of being infected. The model’s positivity and boundedness have been proved, and stability has been examined for disease-free and co-existing equilibrium points to demonstrate the biological meaningfulness of the model. Subsequently, the basic reproduction number (the virus transmission potential (R0)) has been calculated. Next, the sensitivity analysis of the parameters according to R0 has been considered. Moreover, the values of the model parameters have been calculated using the parameter estimation method with real data originating from the United Kingdom. Furthermore, to underscore the benefits of fractional-order differential equations (FODEs), analyses demonstrating their relevance in memory trace and hereditary characteristics have been provided. Finally, numerical simulations have been highlighted to validate our theoretical findings and explore the system’s dynamic behavior. From the findings, we have seen that if the screening rate in the population is increased, more cases can be detected, and stroke development can be prevented. We also have concluded that if the fear in the population is removed, the infection will spread further, and the number of people suffering from a stroke may increase.

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Recombinant tissue plasminogen activator (rTPA) management for first onset acute ischemic stroke with covid -19 and non-covid -19 patients

Cited by 5 publications

References 41 publications

The Impact of Sex Differences on Stroke Risk Factors and 3-Month Outcomes in Patients Receiving Thrombolytic Therapy for Acute Ischemic Stroke

The Impact of Sex Differences on Stroke Risk Factors and 3-Month Outcomes in Patients Receiving Thrombolytic Therapy for Acute Ischemic Stroke

Coronavirus disease 2019 and acute cerebrovascular events: a comprehensive overview

Long-Term Side Effects: A Mathematical Modeling of COVID-19 and Stroke with Real Data

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