Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19

Thiago Carneiro, Jonathan Dashkoff, Lester Y. Leung, Christa O.Hana S. Nobleza, Erika Marulanda-Londono, Mausaminben Hathidara, Sebastian Koch, Nicole Sur, Alexandra Boske, Barbara Voetsch, Hassan Aboul Nour, Daniel J. Miller, Ali Daneshmand, Julie Shulman, Gioacchino Curiale, David M. Greer, Jose Rafael Romero, Pria Anand, Anna M. Cervantes-Arslanian

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background/Purpose: Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19. Methods: We present a multicenter case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA. Results: We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3–26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0–25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml). Conclusions: IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.

Original languageEnglish (US)
Article number105201
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number11
StatePublished - Nov 2020


  • COVID-19
  • IV tPA
  • ischemic stroke
  • thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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