STROKE THROMBOLYSIS DURING THE COVID PANDEMIC IN INDIA - A TALE OF TWO WAVES & LESSONS LEARNT

ABSTRACT

Background: The world was witness to a pandemic never experienced by this generation. The call to arms was answered by each branch of medicine, each fighting separate wars. The war, we as neurologists faced was the “Battle for the Vessels”. Health care workers are a precious resource in Low-Middle-Income-Countries. Hence, exposure to a covidpositive patient for a “full hour” during thrombolysis, isn't warranted. Hence Tenecteplase use which fits the bill “ideally” and “literally” was analysed in this study against Alteplase in strokes with covid-positivity. We analyse the factors which affect their action and the role covid had, in each scenario. Methods: This is an ambi-spective observational study of 37 patients in an apex tertiary-care centre in India. Routine stroke variables were assessed including follow-up imaging, functional outcomes at 3 months. The results were also analysed with the thrombolysis data from covidnegative individuals too in the same period. Results: Among the covid-positive patients 62.16% patients received tenecteplase while 37.83% received alteplase. Although the baseline characteristics were similar, the time-metrics for thrombolysis were significantly favourable in the tenecteplase arm. The median-hospital stay was shorter in the tenecteplase group as was the in-hospital mortality. On follow-up at 3 months, the median mRS-score was significantly favourable in the tenecteplase group. Conclusions: Thrombolysis during the pandemic has been a challenge in many ways especially in resource limited settings. This study shows that there needs to be a conscious and judicial transition towards tenecteplase during the pandemic, where healthcare workers are a precious resource too.