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Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration.
Jillella, Dinesh V; Nahab, Fadi; Nguyen, Thanh N; Abdalkader, Mohamad; Liebeskind, David S; Vora, Nirav; Rai, Vivek; Haussen, Diogo C; Nogueira, Raul G; Desai, Shashvat; Jadhav, Ashutosh P; Czap, Alexandra L; Zha, Alicia M; Linfante, Italo; Hassan, Ameer E; Quispe-Orozco, Darko; Ortega-Gutierrez, Santiago; Khandelwal, Priyank; Patel, Pratit; Zaidat, Osama; Jovin, Tudor G; Kamen, Scott; Siegler, James E.
  • Jillella DV; Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
  • Nahab F; Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
  • Nguyen TN; Interventional Neurology and Neuroradiology, Boston Medical Center, Boston, MA, 02118, USA.
  • Abdalkader M; Department of Neurology, Boston Medical Center, Boston, MA, 02118, USA.
  • Liebeskind DS; Department of Neurology, Ronald Reagan University of California at Los Angeles, Los Angeles, CA, 90095, USA.
  • Vora N; OhioHealth Neuroscience Center, Riverside Methodist Hospital, Columbus, OH, 43214, USA.
  • Rai V; OhioHealth Neuroscience Center, Riverside Methodist Hospital, Columbus, OH, 43214, USA.
  • Haussen DC; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, 30303, USA.
  • Nogueira RG; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, 30303, USA.
  • Desai S; University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, 15219, USA.
  • Jadhav AP; University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, PA, 15213, USA.
  • Czap AL; University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, 15219, USA.
  • Zha AM; University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, PA, 15213, USA.
  • Linfante I; Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, USA.
  • Hassan AE; Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, USA.
  • Quispe-Orozco D; Department of Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Health South Florida, Coral Gables, FL, 33146, USA.
  • Ortega-Gutierrez S; Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, 78550, USA.
  • Khandelwal P; Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
  • Patel P; Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
  • Zaidat O; Department of Endovascular Neurological Surgery and Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA.
  • Jovin TG; Department of Endovascular Neurological Surgery and Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA.
  • Kamen S; Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, 43608, USA.
  • Siegler JE; Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ, 08103, USA.
J Neurol ; 2021 Jul 31.
Article in English | MEDLINE | ID: covidwho-1333064
ABSTRACT

INTRODUCTION:

We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration.

METHODS:

We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.S states. Patients admitted prior to the COVID-19 pandemic (1/1/2019-02/29/2020) were compared to patients admitted during the early pandemic (3/1/2020-7/31/2020). Multivariable logistic regression was used to estimate the effect of IVT delay on discharge to hospice or death, with treatment delay on admission during COVID-19 included as an interaction term.

RESULTS:

Of the 676 thrombolysed patients, the median age was 70 (IQR 58-81) years, 313 were female (46.3%), and the median NIHSS was 8 (IQR 4-16). Longer treatment delays were observed during COVID-19 (median 46 vs 38 min, p = 0.01) and were associated with higher in-hospital death/hospice discharge irrespective of admission period (OR per hour 1.08, 95% CI 1.01-1.17, p = 0.03). This effect was strengthened after multivariable adjustment (aOR 1.15, 95% CI 1.07-1.24, p < 0.001). There was no interaction of treatment delay on admission during COVID-19 (pinteraction = 0.65). Every one-hour delay in IVT was also associated with 7% lower odds of being discharged to home or acute inpatient rehabilitation facility (aOR 0.93, 95% CI 0.89-0.97, p < 0.001).

CONCLUSION:

Treatment delays observed during the COVID-19 pandemic led to greater early mortality and hospice care, with a lower probability of discharge to home/rehabilitation facility. There was no effect modification of treatment delay on admission during the pandemic, indicating that treatment delay at any time contributes similarly to these short-term outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Observational study / Risk factors Language: English Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Observational study / Risk factors Language: English Clinical aspect: Etiology Year: 2021
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