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COVID-19-associated hemostasis alterations and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis

1University of Debrecen; Faculty of Medicine, Debrecen, Hajdu-Bihar, Hungary, 2University of Debrecen; Faculty of Medicine, Department of Laboratory Medicine, Division of Clinical Laboratory Sciences, Debrecen, Hajdu-Bihar, Hungary, 3University of Debrecen; Faculty of Medicine, Department of Neurology, Debrecen, Hajdu-Bihar, Hungary, 4University of Debrecen; Faculty of Medicine, Department of Neurology,, Debrecen, Hajdu-Bihar, Hungary, 5University of Debrecen; Faculty of Medicine, Department of Laboratory Medicine, Debrecen, Hajdu-Bihar, Hungary, 6University of Debrecen; Faculty of Medicine, Department of Neurology and ELKH-DE Neurodegenerative and Cerebrovascular Research Group, Debrecen, Hajdu-Bihar, Hungary, 7University of Debrecen, Faculty of Medicine, Division of Clinical Laboratory Sciences, Debrecen, Hajdu-Bihar, Hungary

Abstract Number: PB0643

Meeting: ISTH 2022 Congress

Theme: Fibrinolysis and Proteolysis » Thrombolytic Therapy

Background: Coronavirus disease-2019 (COVID-19) increases the risk of acute ischemic stroke (AIS). Hemostasis alterations and outcomes of reperfusion therapy (thrombolysis or thrombectomy) in COVID-19-positive AIS patients are not well studied, as yet.

Aims: We aimed to test hemostasis alterations in COVID-19-positive AIS patients receiving intravenous (i.v.) thrombolysis as compared to non-infected AIS patients and to correlate results with therapy outcomes and safety.

Methods: In this prospective observational study, 110 AIS patients receiving i.v. thrombolysis (recombinant tissue plasminogen activator) with/without thrombectomy were enrolled (April 2020-December 2021). Blood samples were taken on admission (within 4.5h of symptom onset), at 1h and 24h post-event. SARS-CoV-2 RT-PCR test performed on admission confirmed acute infection in 9 cases (COVID-19+ group). Anti-SARS-CoV-2 antibody test proved convalescence and/or vaccination in 48 patients (post-COVID/post-vaccination group). Markers of inflammation (CRP, ferritin, IL-6), D-dimer, fibrinogen, von Willebrand factor (VWF) antigen, factor VIII (FVIII) and factor XIII (FXIII) activity, clot-lysis assay, thrombin generation, ROTEM and angiotensin convertase enzyme (ACE)1, ACE2 activities were analyzed. Stroke severity was determined by NIHSS. Therapy-associated intracerebral hemorrhage was classified according to ECASSII criteria. Short- and long-term outcomes were defined at 7 days and 3 months post-event according to the change in NIHSS and the modified Rankin Scale, respectively.

Results: Stroke severity was significantly greater in the COVID-19+ group. VWF antigen levels were markedly elevated in the COVID-19+ group as compared to non-infected and post-COVID/post-vaccination groups (323±72% vs. 248±75% and 222±80%, respectively, p=0.006). FVIII levels were parallel to VWF levels and showed significant elevation in the COVID-19+ group. Short-term outcomes of therapy and the occurrence of hemorrhagic transformation did not differ between groups.

Conclusion(s): Elevated FVIII and VWF levels in COVID-19-associated AIS seem to be linked to endothelial cell injury and are associated with more severe stroke. Efficacy of thrombolysis in COVID-19+ AIS patients was similar to non-infected patients in this cohort.

To cite this abstract in AMA style:

Lóczi L, Orbán-Kálmándi R, Szegedi I, Árokszállási T, Tóth J, Oláh L, Csiba L, Bagoly Z. COVID-19-associated hemostasis alterations and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis [abstract]. https://abstracts.isth.org/abstract/covid-19-associated-hemostasis-alterations-and-outcomes-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis/. Accessed June 6, 2023.

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