Partial Recanalization of a Large Vessel Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator, Followed by Systemic Anticoagulation, in the Setting of COVID-19-Induced Hypercoagulability: A Case Report. (July 2021)

• Record Type: Journal Article
• Authors: LaBarbera, Vincent A.; Azher, Aidan; Jayaraman, Mahesh V.; Wendell, Linda C.; Sacchetti, Daniel C.; Thompson, Bradford
• Is Part Of: Neurohospitalist. Volume 11:Number 3(2021)
• Page Start: 246
• Page End: 250
• Publication Date: 2021-07
• Subjects: case report -- tissue plasminogen activator -- COVID-19 -- ischemic stroke -- anticoagulation; Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8
• DOI: 10.1177/1941874420977308
• Languages: English
• ISSNs: 1941-8744

Abstract

We report on the use of systemic heparinization following thrombolysis with intravenous tissue plasminogen activator (t-PA) for acute ischemic large vessel stroke, in the setting of COVID-19-induced hypercoagulability, with partial recanalization of the internal carotid artery. Off-label systemic heparinization was used within 12 hours of t-PA administration, after extensive multidisciplinary collaboration and family discussion, given evidence of severe hypercoagulability. We conclude that thrombolysis should be considered for all eligible patients with suspected or confirmed COVID-19 and acute ischemic stroke, and systemic anticoagulation, although with inherent risks, may be a useful adjunct treatment modality in selected patients who have received intravenous thrombolysis.