Evidence map›Paper›PMID 34601242›Full record

Observational studyJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2021

Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.

Payam Sasanejad, Leila Afshar Hezarkhani, Shahram Arsang-Jang, Georgios Tsivgoulis, Abdoreza Ghoreishi, Kristian Barlinn, Jan Rahmig, Mehdi Farhoudi, Elyar Sadeghi Hokmabadi, Afshin Borhani-Haghighi and 46 more

Open access · bronzeAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
3.0field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Recombinant tissue plasminogen activator (rTPA) management for first onset acute ischemic stroke with covid -19 and non-covid -19 patients.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2023
    Article
  5. Article
  6. Review
  7. Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review.Current treatment options in neurology · 2023
    Review
  8. Review
  9. Review
  10. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

56 authors at 20 institutions in 13 countries.

Payam SasanejadDepartment of Neurology Mashhad Fellowship of interventional radiology Mashhad University of Medical Sciences. Electronic address: reza.azarpazhooh@lhsc.on.ca.
Leila Afshar HezarkhaniDepartment of Neurology School of Medicine Farabi Hospital Kermanshah University of Medical Sciences, Kermanshah, Iran.
Shahram Arsang-JangDepartment of Biostatistics and Epidemiology School of Medicine Zanjan University of Medical Sciences, Zanjan, Iran.
Georgios TsivgoulisSecond Department of Neurology National & Kapodistrian University of Athens,Professor of Neurology, Athens, Greece.
Abdoreza GhoreishiDepartment of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences.
Kristian BarlinnUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden.
Jan RahmigDepartment of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Mehdi FarhoudiNeurosciences Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Elyar Sadeghi HokmabadiNeurosciences Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz.
Afshin Borhani-HaghighiClinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Payam SariaslaniDepartment of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Athena Sharifi-RazaviClinical Research Development Unit of Bou-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Kavian GhandehariDepartment of Neurology Mashhad University of Medical Sciences, Mashhad, Iran.
Alireza KhosraviClinical Immunology Research Center, Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
Craig SmithManchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
Yongchai NilanontSiriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Yama AkbariDepartments of Neurology, Neurological Surgery, and Anatomy & Neurobiology, and Beckman Laser Institute & Medical Clinic, School of Medicine, University of California, Irvine, CA, USA.
Thanh N NguyenBoston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Anna BersanoCerebrovascular Unit, Fondazione IRCCS Istituto Neurologico carlo Besta, Milano, Italy.
Nawaf YassiDepartment of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
Takeshi YoshimotoDepartment of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Simona LattanziDepartment of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy.
Animesh GuptaDepartment of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
Ramin ZandDepartment of Neurology, Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA.
Shahram RafieDepartment of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Seyede Pourandokht MousavianDepartment of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad Reza ShahsavaripourDepartment of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
Shahram AminiDepartment of Anesthesia, Intensive care Unit, Lung Research Center, Mashhad, Mashhad University of Medical Sciences.
Saltanat U KamenovaDepartment of Medicine, Al-Farabi Kazakh National University, Doctor of Medical Science, Professor. Almaty, Kazakhstan.
Aida KondybayevaDoctor of Medical Science, Professor Doctor of Medical Science, Professor, Department of Medicine, Al-Farabi Kazakh National University. Almaty, Kazakhstan.
Murat ZhanuzakovDoctor of Medical Science Professor, Department of Internal Medicine, Kazakh-Russian Medical University. Almaty, Kazakhstan.
Elizabeth M MacriDepartment of Neurology, University of New Mexico, Albuquerque, NM.
Christa O'Hana S NoblezaDepartment of Neurology, University of Mississippi Medical Center, Jackson, MS.
Sean RulandDepartment of Neurology, Loyola University Chicago-Stritch School of Medicine, Chicago, IL.
Anna M Cervantes-ArslanianDepartments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston University School of Medicine, Boston Medical Center, Boston, MA.
Masoom J DesaiAssistant Professor of Neurology, University of New Mexico, Albuquerque.
Annemarei RantaDepartment of Medicine, University of Otago, Wellington and Department of Neurology, Wellington Regional Hospital, New Zealand.
Amir Moghadam AhmadiAssociate Professor of Neurology, School of Medicine, Non-communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Mahtab RostamihosseinkhaniClinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Razieh ForoughiClinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Etrat HooshmandiClinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Fahimeh H AkhoundiDepartment of Neurology, Iran University of medical Sciences, Tehran, Iran.
Ashfaq ShuaibProfessor of Neurology and Director Stroke Program University of Alberta, Alberta, Canada.
David S LiebeskindUCLA Stroke Center, Los Angeles, CA, USA.
James SieglerCooper Neurological Institute, Cooper University Hospital, Camden, NJ.
Jose G RomanoDepartment of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Stephan A MayerProfessor of Neurology and Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
Reza Bavarsad ShahripourUniversity of California San Diego Neurosciences center, Comprehensive Stroke center, San Diego, CA.
Babak ZamaniDepartment of Neurology, Iran University of Medical Sciences, Tehran, Iran.
Amadene WoolseyStroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada. Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
Yasaman FazliSchool of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Khazaei MojtabaAssistant Professor of Neurology, Assistant Professor of Neurology, Hamadan Medical University of Medical Sciences, Fellowship of neurovascular intervention.
Christian F IsaacDepartment of Neurology, Hospital Dr Arturo Oñativia, Argentina.
Jose BillerDepartment of Neurology, Loyola University Health System, Stritch School of Medicine, Chicago, IL, USA.
Mario Di NapoliDepartment of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
M Reza AzarpazhoohStroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
Mashhad University of Medical Sciences · IRShiraz University of Medical Sciences · IRUniversity of New Mexico · USAl-Farabi Kazakh National University · KZBoston University · USIran University of Medical Sciences · IRKermanshah University of Medical Sciences · IRTabriz University of Medical Sciences · IRUniversity Hospital Carl Gustav Carus · DEWestern University · CAZanjan University of Medical Sciences · IRAhvaz Jundishapur University of Medical Sciences · IRCooper University Hospital · USEllis Hospital · USFondazione IRCCS Istituto Neurologico Carlo Besta · ITGeisinger Medical Center · USHamedan University of Medical Sciences · IRHospital Dr Arturo Oñativia · ARKazakhstan Medical University · KZLoyola Medicine · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.

methodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.

resultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).

conclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Indexed as

Thrombolytic TherapyAgedAged, 80 and overCOVID-19Disability EvaluationEuropeFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesIranIschemic StrokeMaleMiddle AgedFibrinolytic AgentsCOVID-19deathDisabilityLongitudinal studyOutcomesSafetyStrokeStroke severityThrombolytic therapy

Identifiers

PMID34601242
PMCPMC8450304
OpenAlexW3199382643

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.