Global Decline in Stroke and IV Thrombolysis Hospitalizations Early in COVID-19 Pandemic

Medical illustration of a brain with stroke symptoms
Investigators conducted a cross-sectional study to measure the global impact of the COVID-19 pandemic on intravenous thrombolysis volume and stroke hospitalizations.

A global trend of fewer hospital admissions for stroke and intravenous thrombolysis (IVT) was observed early in the COVID-19 pandemic, according to results of a cross-sectional, retrospective study published in Neurology.

Study researchers conducted a cross-sectional, observational, retrospective study. They assessed data for patient hospitalizations at 457 centers in 70 countries across 6 continents for the volume of stroke and IVT admissions during the pandemic (March 1 to June 30, 2020) and compared data with prepandemic rates (November 2019 to February 2020).

During the pandemic, 80,894 patients were hospitalized for stroke and 11,570 for IVT compared with 91,373 and 13,334 immediately before the pandemic, respectively.

Compared with before the pandemic, during the pandemic there was an 11.5% decrease (95% CI, -11.7% to -11.3%; P <.0001) in stroke hospitalizations. Stratified by geographic region, Africa had a 30.2% decline, North America 18.8%, South America 17.4%, Europe 10.0%, and Asia 7.1% (all P <.0001). Centers in Oceania did not report a decline in stroke hospitalization (-1.9%; 95% CI, -2.5% to -1.5%; P =.3).

There appeared to be a recovery in numbers of stroke hospitalizations: Compared with the first 2 months of the pandemic, stroke volumes increased by 9.5% (95% CI, 9.2% to 9.8%; P <.0001) during the third and fourth months.

The IVT admissions decreased by 13.2% (95% CI, -13.8% to -12.7%; P <.0001) during the pandemic. Similar patterns were observed geographically, in which South America had the greatest decrease (24.2%) followed by Africa (23.5%), North America (14.4%), Europe (13.4%), and Asia (10.1%), with no significant difference for centers in Oceania (-1.9%; 95% CI, -3.9% to -0.92%; P =.7).

Center type was significant. Primary stroke centers had more dramatically reduced stroke and IVT admission rates (-17.3% and -15.5%) than comprehensive stroke centers (-10.3% and -12.6%), respectively.

Among all patients hospitalized for COVID-19, 1.48% had a stroke. The prevalence of stroke among patients with COVID-19 was highest in South America (3.0%) and lowest in Oceania (0.4%). Among patients hospitalized with stroke, 3.3% had SARS-CoV-2 infections. More patients with stroke in South America (8.4%) had COVID-19 and the fewest with infections were reported in Oceania (0.5%).

This study may have been limited by regional variation of diagnosis and delivery of care for stroke and IVT.

These findings suggested there was a global decline in stroke and IVT hospital admissions associated with the early part of the COVID-19 pandemic.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.


Nogueira RG, Qureshi MM, Abdalkader M, et al. Global impact of COVID-19 on stroke care and intravenous thrombolysis. Neurology. Published online March 25, 2021. doi:10.1212/WNL.0000000000011885