Confirmed ischemic stroke rates low in COVID-19
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Patients hospitalized with COVID-19 had low rates of ischemic stroke confirmed by imaging, according to a study published in Stroke.
The study also found that most strokes in these patients were cryptogenic and were linked to increased mortality.
“As centers develop protocols for the prompt triage and assessment of patients with COVID-19, the co-occurrence of stroke and COVID-19 should be considered when weighing these risks,” Shadi Yaghi, MD, FAHA, director of vascular neurology at NYU Langone Hospital-Brooklyn, director of clinical vascular neurology research at NYU Langone Health and assistant professor in the department of neurology at NYU Grossman School of Medicine, told Healio. “Second, stroke in the setting of COVID-19 could be a manifestation of systemic hypercoagulability as shown in our patient cohort with higher D-dimer levels when compared to patients who tested negative for the virus.”
COVID-19 in New York
Researchers analyzed data from patients who were hospitalized for COVID-19 in the New York metropolitan area between March 15 and April 19. Two control groups were formed in this study; a contemporary control group included patients with stroke and without COVID-19, and a historical control group included patients who were discharged with a diagnosis of ischemic stroke between March 15 and April 15.
All patients underwent a standard diagnostic evaluation per institutional protocol. Other information was abstracted from medical records including clinical and demographic variables, imaging variables, laboratory variables, discharge outcomes and in-hospital treatments. COVID-19 screening was performed at first provider contact.
Of the 3,556 patients who were hospitalized for COVID-19, 0.9% (n = 32; median age, 63 years; 72% men) had an ischemic stroke that was radiologically proven. The median time from the onset of COVID-19 symptoms to stroke identification was 10 days. Patients with COVID-19 and stroke were more likely to have cryptogenic stroke (65.6%) compared with the contemporary control (30.4%; P = .003) and historical control groups (25%; P < .001).
Compared with the contemporary control group, those with stroke and COVID-19 had higher peak D-dimer levels (> 10,000 ng/mL vs. 525 ng/mL; P = .011) and higher admission NIH Stroke Scale scores (19 vs. 8; P = .007). Patients with COVID-19 and stroke were more likely to be men (71.9% vs. 45%; P = .012) and had positive troponin levels (45.2% vs. 8.1%; P < .001), higher erythrocyte sedimentation rate levels (79 vs. 41; P = .001) and higher NIH Stroke Scale scores (19 vs. 3; P = .001) compared with the historical control group.
The mortality rate was higher in patients with COVID-19 and stroke compared with contemporary (63.6% vs. 9.3%; P < .001) and historical control groups (63.6% vs. 6.3%; P < .001).
Further research
“Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19,” Yaghi said in an interview.
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.
For more information:
Shadi Yaghi, MD, FAHA, can be reached at shadiyaghi@yahoo.com; Twitter: @shadiyaghi2.
Disclosures: Yaghi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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