key: cord-0927664-o0y111cc
authors: Gao, Xiaogang
title: The choice of intravenous thrombolysis for Acute Ischemic Stroke under COVID-19 infection
date: 2020-05-28
journal: Clin Neurol Neurosurg
DOI: 10.1016/j.clineuro.2020.105968
sha: f9aceaef860d96c4573d0ba43e9388f2655de7b5
doc_id: 927664
cord_uid: o0y111cc

nan

Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro

The WHO has declared a pandemic of SARS-CoV-2, the cause of COVID-19, which began in December 2019. Most of the critical patients attacked by COVID-19 were middle-aged and the elderly. They usually suffer from an abnormal increase in D-Dimer [1] , which is closely related to the onset of embolic vascular events, and a higher risk of cerebrovascular diseases. Hence, they are more likely to have an Acute Ischemic Stroke (AIS). To pay attention to the treatment of COVID-19 patients with AIS by medical staff becomes essential. The key to AIS treatment is early vascular recanalization to save ischemic penumbra. Intravenous thrombolysis is the major means to restore vascular recanalization, as well as the first choice in the guidelines of various countries [2, 3] . The summary analysis of randomized controlled intravenous thrombolysis further confirmed a clear benefit of intravenous rt-PA thrombolysis within 4.5 h after the onset of AIS, the earlier the thrombolysis time, the greater the benefit [4] . At present, completing the thrombolysis within 60 min from the emergency admission, and minimizing the time from admission to thrombolysis (DNT) are advocated [3] . However, the prevention and control measures for infectious diseases, as well as the epidemiological investigation, blood and imaging examination, all prolong the time for patients to receive intravenous thrombolysis. Currently, COVID-19 is spreading throughout the world at a high speed. In the face of this serious public health event, we suggest adjusting the intravenous thrombolysis process of acute ischemic stroke by taking the following measures (Fig. 1 ).

1 Patient transfer: The confirmed or suspected patients of COVID-19

should contact emergency medical services (EMS) and be transferred by negative pressure emergency vehicles to medical institutions with isolation and intravenous thrombolysis conditions. Medical staff and accompanying people must take protective measures. Patients who seek medical treatment by themselves should take private transportation, rather than the public transportation. 2 Hospital visit: The AIS patients should be treated by both neurologists and infectious (respiratory) physicians. Those with fever or especially respiratory symptoms, first go to a fever outpatient clinic. If being suspected of SARS-CoV-2 infection, they will be admitted to the hospital isolation ward for the rapid nucleic acid test. Within reperfusion time, patients should take thrombolytic therapy immediately, regardless of the results of the rapid nucleic acid test. Second, patients with AIS but no respiratory symptoms and fever can receive treatment in the stroke center, where routine blood tests and chest CT should be carried out to screen the asymptomatic infection. As suspected of SARS-CoV-2 infection, they will be admitted to the hospital isolation ward. If the suspicion of COVID-19 is Available online 28 May 2020 0303-8467/ © 2020 Elsevier B.V. All rights reserved. T eliminated, patients will be sent to a single ward of the neurology department, instead of the neurology intensive care unit (NICU) and given Intravenous thrombolysis according to guidelines. When patients keep body temperature within the normal range and show negative manifestations in blood routine tests, lung CT and the nucleic acid test for three consecutive days, they will be allowed to stay in the ward with multiple beds. 3 Unstable patients with severe pneumonia: This group of patients will be transferred to the isolation ward or ICU, and intravenous thrombolysis can be ignored.

Against the global prevalence of COVID-19, AIS treatment should be carried out on the premise that the spread of COVID virus is hindered, so as to gain satisfactory results.

Clinical features of patients infected with 2019 novel coronavirus in

Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association

A randomized trial of intraarterial treatment for acute ischemic stroke