COVID‐19–Associated Encephalopathy and Cytokine‐Mediated Neuroinflammation

Abstract

should be noted that entries on antiplatelet status, follow-up imaging, and 3-month outcomes seem to be missing at random, as we were not able to identify any particular pattern on missing values. 2 Therefore, we decided to exclude patients with missing data in any of these variables rather than use imputation strategies or algorithms that could increase even more residual bias and lead to erroneous conclusions.Safe Implementation of Treatments in Stroke (SITS) is a nonprofit, research-driven, independent, international collaboration that reflects clinical experience from several countries and institutions.SITS data, as captured in the International Stroke Thrombolysis Register (ISTR), have been used to date in numerous research projects published in high impact medical journals.Some of these SITS-ISTR publications had a direct impact on clinical practice and guideline recommendations, such as on the extension of time window to 4.5 hours and elimination of the upper age limit for intravenous thrombolysis administration in otherwise eligible patients with acute ischemic stroke. 3,4 Finally, we welcome the analyses provided by the TRISP collaborators using data from the TRISP registry and we are particularly glad to see our findings being replicated in another multicenter registry (Fig).This analysis also includes patients with prior disability, who were originally excluded from our study.However, the definition of prior disability used in TRISP (mRS = 3-5) is not the same that we excluded from our analysis (mRS = 2-5).Although the TRISP collaborators suggest that intravenous thrombolysis administration is potentially safe for patients with history of disability and dual antiplatelet treatment, the absolute number of patients with disability receiving dual antiplatelet treatment is very limited in the TRISP registry to draw any firm conclusions.The adjusted associations presented by the TRISP collaborators provide a further independent confirmation of the findings from previous observational studies suggesting that patients on dual antiplatelet therapies prior to index stroke onset have similar safety outcomes and risks compared with patients without history of any antiplatelet intake. 5 Based on the evidence we have so far, we highlight once again that history of dual antiplatelet pretreatment should not be used as a reason to withhold intravenous thrombolysis in otherwise eligible patients with acute ischemic stroke.The safety of intravenous thrombolysis administration in patients with both history of dual antiplatelet intake and baseline functional disability deserves to be further investigated.

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