PB0643 - COVID-19-associated hemostasis alterations and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

Linda Lóczi

PhD Student
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary

Presenting Author(s)

Rita Orbán-Kálmándi

Junior research fellow
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary

Co-Author(s)

IS

István Szegedi

Post-doc student
University of Debrecen; Faculty of Medicine, Department of Neurology
Debrecen, Hajdu-Bihar, Hungary
T�

Tamás Árokszállási

Clinical neurologist, PhD student
University of Debrecen; Faculty of Medicine, Department of Neurology,
Debrecen, Hajdu-Bihar, Hungary
JT

Judit Tóth

Assistant lecturer
University of Debrecen; Faculty of Medicine, Department of Laboratory Medicine
Debrecen, Hajdu-Bihar, Hungary
LO

László Oláh

Full professor
University of Debrecen; Faculty of Medicine, Department of Neurology,
Debrecen, Hajdu-Bihar, Hungary
LC

László Csiba

Full professor
University of Debrecen; Faculty of Medicine, Department of Neurology and ELKH-DE Neurodegenerative and Cerebrovascular Research Group
Debrecen, Hajdu-Bihar, Hungary
Zsuzsa Bagoly, MD, PhD

Professor (Associate)
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary

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.