Letter to Editor: Consideration Needed for Early Anticoagulation Following Intravenous tPA in Patients with COVID-19
We read the article by Carneiro et al with great interest1. We have similar experiences at two downtown Los Angeles certified stroke centers with the use of intravenous tPA. However, there are concerning observations lately among COVID-19 patients who developed large vessel re-occlusions shortly after their original stroke symptoms were aborted by intravenous tPA.
Publication date: Available online 9 October 2020Source: Neurología (English Edition)Author(s): J.P. Martínez-Barbero, P. Tomás-Muñoz, R. Martínez-Moreno
Authors: Mantero V, Rigamonti A, Basilico P, Sangalli D, Scaccabarozzi C, Salmaggi A PMID: 33029982 [PubMed]
We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection.
In the rapidly evolving COVID-19 pandemic, many patients presenting with acute ischemic stroke may be potentially infected with the Severe Acute Respiratory Syndrome Coronavirus (SARS CoV-2) agent. As stroke patients are often unable to give an adequate history of preceding COVID-19 symptoms, all stroke patients in areas with high prevalence of community transmission should be considered potential cases. Observational studies have suggested an increased tendency for thrombotic events in patients infected with SARS CoV-2.
Background: The COVID-19 pandemic might affect health care resources and alter patient admission to hospital in case of stroke or transient ischemic attack (TIA). We aim to determine whether the COVID-19 pandemic is affecting utilization of recanalization procedures and numbers of patients with stroke and TIA admitted to a primary care stroke center.Methods: In this retrospective observational study, we compared patients admitted from January 2019 until February 2020 with patients admitted during the COVID-19 pandemic (March/April 2020) in Germany. We included patients with stroke (hemorrhagic or ischemic) or TIA as classi...
This study also found that a number of patients with COVID suffered strokes. In fact, COVID infection is a risk factor for strokes. A group of Canadian doctors found that individuals over 70 years of age were at particularly high risk for stroke related to COVID infection, but even young individuals are seven times more likely to have a stroke from this coronavirus versus a typical flu virus. Autopsy data from COVID patients in Finland suggests that another major cause of brain damage is lack of oxygen. Particularly worrisome is that several of the patients who were autopsied did not show any signs of brain injury during t...
(Penn State) A large, international study of COVID-19 patients confirmed that cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease, stroke and cancer can increase a patient's risk of dying from the virus.
ConclusionsZoom conferences are a promising technology for stroke services. Further studies are needed to further elucidate their benefits and drawbacks.