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Abstract Details

Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
002
To evaluate the safety and efficacy of IV tPA in patients with stroke and COVID-19.
Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19.
We present a multi-center case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA.
We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3–26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0–25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml).
IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.
Authors/Disclosures
Thiago S. Carneiro, MD
PRESENTER 		Dr. Carneiro has nothing to disclose.
Jonathan Dashkoff, MD, PhD (Brigham & Women's Hospital) Dr. Dashkoff has nothing to disclose.
Lester Y. Leung, MD (Tufts Medical Center) Dr. Leung has received research support from NIH.
Christa O'hana S. Nobleza, MD Dr. Nobleza has nothing to disclose.
Erika T. Marulanda, MD, FÂ鶹´«Ã½Ó³»­ (University of Miami) Dr. Marulanda has nothing to disclose.
Mausaminben Y. Hathidara, MD (University of Pittsburgh Medical Center) Dr. Hathidara has nothing to disclose.
Sebastian Koch, MD (University of Miami) Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
Nicole B. Sur, MD (University of Miami) Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
Alexandra C. Boske, MD Dr. Boske has nothing to disclose.
Barbara Voetsch, MD, PhD (Massachusetts General Hospital) The institution of Dr. Voetsch has received research support from NIH StrokeNet . Dr. Voetsch has received publishing royalties from a publication relating to health care. Dr. Voetsch has received personal compensation in the range of $500-$4,999 for serving as a International Stroke Conference attendee (travel-related expenses) with AHA/ASA. Dr. Voetsch has received personal compensation in the range of $500-$4,999 for serving as a member of the Quality Metrics Subcommittee (travel-related expenses) with Â鶹´«Ã½Ó³»­. Dr. Voetsch has a non-compensated relationship as a member of the Massachusetts Systems of Care Workgroup with AHA/ASA that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Hassan Aboul Nour, MD Dr. Aboul Nour has nothing to disclose.
Daniel Miller, MD Dr. Miller has nothing to disclose.
Ali Daneshmand, MD (Boston University School of Medicine) Dr. Daneshmand has nothing to disclose.
Julie G. Shulman, MD (Boston Medical Center) Dr. Shulman has received research support from the BU Spivack Neuroscience Pilot Award.
Gioacchino Curiale, MD Dr. Curiale has received personal compensation for serving as an employee of Biogen. Dr. Curiale has stock in Biogen.
David M. Greer, MD, FÂ鶹´«Ã½Ó³»­ (Boston University School of Medicine) Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Jose R. Romero, MD (Boston University School of Medicine - Boston Medical Center) The institution of Dr. Romero has received research support from NIH/NIA.
Pria Anand, MD (Boston University School of Medicine) Dr. Anand has nothing to disclose.
Anna Marisa Cervantes-Arslanian, MD, FÂ鶹´«Ã½Ó³»­ (BU Dept of Neurology) Dr. Cervantes-Arslanian has nothing to disclose.