Treatment of stroke during the 2019 coronavirus disease (COVID-19) pandemic was associated with a significant delay in thrombolysis compared to pre-pandemic treatment, according to study results published in Stroke.
The study’s researchers wanted to find out whether the COVID-19 pandemic contributed to delays in the treatment and management of acute strokes. To achieve this, they conducted a retrospective study based on a pooled analysis of clinical data from consecutive adult patients with stroke treated at 14 major stroke centers in the United States between January 1, 2019 and July 31, 2020. The study researchers compared the rate of thrombolysis for non-transferred patients within the target: stroke goal of 60 minutes in 1,491 patients admitted before the COVID-19 pandemic (March 1, 2019 to July 31, 2019) in 1,464 patients who were during the Pandemic (March 1, 2019) were recorded 2020 to July 31, 2020).
Approximately 15% of the patients underwent intravenous thrombolysis. Patients treated during the COVID-19 pandemic were less likely to receive thrombolysis within 60 minutes of arrival than patients treated prior to the pandemic (odds ratio) [OR]0.61; 95% CI, 0.38-0.98; P = 0.04). There was a mean door-to-needle delay of 4 minutes (P = 0.03) in patients treated during the pandemic.
The lower likelihood of achieving treatment on target: The stroke target remained in place even after adjusting the variables associated with previous therapy (adjusted OR, 0.55; 95% CI, 0.35-0.85; P <0.01 ). In addition, the delay in thrombolysis continued through June and July.
The results indicated that the main factor that contributed to the delay in thrombolysis was the longer delay from imaging to bolus (median 29 vs 22 minutes; P = 0.02). The study researchers found no significant delay in door-to-groin puncture in patients who received thrombectomy (median 83 vs. 90 minutes; P = 0.30).
One limitation of the study was its retrospective nature, which may have led to a lack of data, including a lack of stroke diagnoses. In addition, limited data was available from each stroke center’s potential registry.
“Since the delay in care appears to be primarily due to the time from image acquisition to induction of thrombolysis,” the researchers concluded, “the centers are encouraged to reassess their local paradigms to expedite stroke treatment once an intracranial occurs Bleeding is excluded. ”
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Siegler JE, Zha AM, Czap AL et al. Influence of the COVID-19 pandemic on treatment times for acute ischemic stroke: Multicenter Collaboration of the Society of Vascular and Interventional Neurology. Stroke. Published online November 30, 2020. doi: 10.1161 / STROKEAHA.120.032789