Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19

So your doctors are still guessing what to do if you present with a stroke and COVID-19. 

I'm going to be asking for heparin as a blood thinner because of this:

Common FDA-approved drug may effectively neutralize virus that causes COVID-19

to try to prevent that stroke. 

Th latest here:

Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19

Author links open overlay panelThiagoCarneiroMD¹

JonathanDashkoffMD PhD¹Lester Y.LeungMD MSc²Christa O'Hana S.NoblezaMD MSCI³ErikaMarulanda-LondonoMD⁴MausaminbenHathidaraMD⁴SebastianKochMD⁴NicoleSurMD⁴AlexandraBoskeMD⁵BarbaraVoetschMD PhD⁶Hassan AboulNourMD⁷Daniel JMillerMD⁷AliDaneshmandMD MPH¹JulieShulmanMD¹GioacchinoCurialeMD¹David M.GreerMD MA¹Jose RafaelRomeroMD¹⁸PriaAnandMD^1†Anna M.Cervantes-ArslanianMD^1†

https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105201Get rights and content

Abstract

Background/Purpose: 
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.

Methods:
We present a multicenter 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.

Results: 
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).

Conclusions:
IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.

Introduction

Preliminary reports suggest that patients with Coronavirus Disease 2019 (COVID-19) are at high risk of hematologic complications, including disseminated intravascular coagulation (DIC).^1,2,3 Patients with COVID-19 may exhibit hemostatic abnormalities with the potential to precipitate both hemorrhagic and thromboembolic events, including mild thrombocytopenia, prolongation of both prothrombin time and international normalized ratio, and shortened activated partial thromboplastin time, and both ischemic stroke and intracerebral hemorrhage have been described in infected patients.^4,5,6,7 However, limited evidence exists in the literature for management of acute stroke in COVID-19 given the concomitant risk of hemorrhage, and recommendations are based on consensus only.⁸

The safety and efficacy of intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke in patients with COVID-19 remain unknown.¹ We present the outcomes of a multicenter series of patients with confirmed COVID-19 infection who were treated with IV tPA for suspected acute ischemic stroke.