P.058 Reasons for withholding tissue Plasminogen Activator (tPA) administration during the COVID-19 pandemic at a tertiary stroke centre

Abstract

Background: Stroke is a leading cause of death and disability worldwide, including Canada. Treatments for stroke are time dependent and IV tPA for acute ischemic stroke decreases the chance of disability at 90 days if given within 4.5 hours of symptom onset. The onset of the Covid-19 pandemic was initially associated with a decrease in acute stroke treatment with thrombolysis across North America. These decreases seemed transient, with a rebound in numbers seen in other provinces across Canada as widespread lockdown orders were lifted. However, a rebound in thrombolysis was not seen at Royal University Hospital (RUH) in Saskatoon, Saskatchewan during the same period. We will analyze documented reasons why thrombolysis was withheld. Methods: We conducted a retrospective chart review of adult patients with ischemic strokes presenting within 4.5 hours of symptom onset to the RUH from March 2019 –January 2021. We received a waiver of consent from the Research Ethics Board. Results: 128 patients met the inclusion criteria. Statistical analysis is currently ongoing. Conclusions: Initial results suggest that there are similar reasons for withholding tPA before and after the Covid-19 pandemic. The main reasons include rapidly resolving/resolved symptoms and a documented tPA exclusion criterion.