Intravenous Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study

Abstract

Introduction Changes in intravenous thrombolysis treatment rates for acute ischaemic stroke during the COVID-19 pandemic have been reported. We examined the differences in the provision of intravenous thrombolysis in patients with acute ischaemic stroke, two years prior to and two years into the COVID-19 pandemic. Methods Data were compared between March 1, 2018 to February 28, 2020 (Pre-COVID-19) and March 1, 2020 to February 28, 2022 (COVID-19). Data collected included patients’ demographics, intravenous thrombolysis rates, and patient outcomes. Results There was an increase in ischaemic stroke patient admissions during the COVID-19 period (Pre-COVID-19 n=1041, vs COVID-19 n=1087). Yet, fewer stroke patients received intravenous thrombolysis (19.2% vs 13.9%, p<0.001), and there were more stroke mimics thrombolysed (8.3% vs 15.6%, p=0.021) during this period. During the COVID-19 period, there was a significant delay in hospital presentation for patients who were thrombolysed (Pre-COVID-19 = 86 minutes vs COVID-19 = 107 minutes, p = 0.004); and delay in giving thrombolysis (median door to needle time: Pre-COVID-19 = 59 minutes vs COVID-19 = 65 minutes, p = 0.002). Fewer patients had severe stroke symptoms (National Institute of Health Stroke Scale score = >15) (12.2% vs 4.8%, p=0.009) during the COVID-19 period. There was no significant difference in patients’ post-thrombolysis outcome (median National Institute of Health Stroke Scale score = 1, p=0.136; discharge modified Rankin Scale score = 1, p=0.647; and mortality p=0.655). Conclusion This study showed that during the first 2 years of the COVID-19 pandemic, there was a significant decline in the thrombolysis rates and delay in the administration of the intravenous thrombolysis treatment.