Fast Five Quiz: Stroke

Richard H. Sinert, DO

Disclosures

November 06, 2020

An international panel of stroke experts from 18 countries released recommendations for managing patients with acute ischemic stroke who have either suspected or confirmed COVID-19. The following are among the 41 conclusions and practice implications:

  • If a patient with stroke is suspected to have COVID-19, pulmonary imaging using CT and/or radiography may be helpful in identifying radiologic abnormalities suggestive of COVID-19.

  • The purpose of CTA and perfusion images is to select patients for mechanical thrombectomy and can be avoided if mechanical thrombectomy is not considered owing to poor patient condition or patient/family wishes.

  • Consistent with existing data, antiplatelet therapy may be avoided if possible for the first 24 hours after receiving intravenous rt-PA and mechanical thrombectomy in patients with stroke patients who have suspected or confirmed COVID-19, until the risk can be better defined. Single- or dual-antiplatelet therapy may be considered in patients with acute ischemic stroke who do not receive intravenous rt-PA and/or mechanical thrombectomy in patients with suspected or confirmed COVID-19.

  • Intravenous rt-PA is recommended for selected patients. Hepatic dysfunction manifesting with coagulopathy can occur in patients with COVID-19. The current guidelines specify certain eligibility thresholds; however, there is ambiguity regarding thresholds associated with greater risk or benefit with intravenous rt-PA.

Read more clinical guidance about COVID-19.

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