Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration

• Authors: Dinesh Jillella, Emory University; Fadi Nahab, Emory University; Thanh N Nguyen, Boston Medical Center; Mohamad Abdalkader, Boston Medical Center; David S Liebeskind, University of California at Los Angeles; Nirav Vora, Riverside Methodist Hospital; Vivek Rai, Riverside Methodist Hospital; Diogo Haussen, Emory University; Raul Nogueira, Emory University; Shashvat Desai, University of Pittsburgh; Ashutosh P Jadhav, University of Pittsburgh; Alexandra L Czap, University of Texas McGovern Medical School, Houston; Alicia M Zha, Univ Texas Houston; Italo Linfante, Baptist Health South Florida; Ameer E Hassan, University of Texas Rio Grande Valley; Darko Quispe-Orozco, University of Iowa Hospitals and Clinics; Santiago Ortega-Gutierrez, University of Iowa Hospitals and Clinics; Priyank Khandelwal, Robert Wood Johnson University Hospital; Pratit Patel, Robert Wood Johnson University Hospital; Osama Zaidat, Mercy Health St. Vincent Hospital; Tudor G Jovin, Cooper University Hospital; Scott Kamen, Rowan University; James E Siegler, Cooper University Hospital
• Journal Title: JOURNAL OF NEUROLOGY
• Volume: Volume 269, Number 2
• Publisher: SPRINGER HEIDELBERG | 2021-07-31, Pages 603-608
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s00415-021-10734-z
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Neurosciences & Neurology; Stroke; COVID-19; Thrombolysis; Treatment delay; Outcomes; Mortality; STROKE; TIMES

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.