COVID-related strokes are especially severe and the results are worse

According to a UK case-control study, ischemic stroke in patients with COVID-19 tended to be more severe than in other individuals.

Of the 86 stroke patients with COVID-19, stroke characteristics and outcomes were different from non-infectious stroke patients treated during the same period. COVID-19-related strokes:

• It was likely to be accompanied by multiple large vessel occlusions (17.9% vs 8.1%, P<0.03)
• It was more serious (median NIH stroke scale score 8 to 5) P<0.002)
• Was associated with higher D-dimer levels (3.4 vs. 3.0 ng / ml in log)_Ten scale, P<0.01)
• Caused more severe disability at discharge (median modified Rankin scale score 4 to 3) P<0.0001)
• The number of deaths during index hospitalization increased (19.8% vs. 9.6%, P<0.0001)

“Our research provides the most compelling evidence to date. COVID-19-related ischemic stroke According to a group led by Richard Perry, BM, BCh, and PhD of the UCL Queen Square Institute, the outlook is not as dark as previous studies suggest, but it is more severe and can lead to severe disability or death. Will be higher. Neurology and National Neurology Neurosurgery Hospital, London.The complete manuscript Was published in Journal of Neurology, Neurosurgery & Psychiatry..

Patients admitted to 13 centers in the United Kingdom and Scotland between March 9 and July 5 this year had a median time from onset of COVID-19 symptoms to the onset of ischemic stroke in 6 days.

“Data is Previous Report Focusing on Stroke Related to COVID-19 Larry B. Goldstein, MD, Ph.D., University of Kentucky, Lexington, commented.

“Macrovascular stroke affects a larger area of ​​the brain and is generally more severe, which is also consistent with the results of this study. This can cause stroke in people with COVID-19. It may be partly related to an increased tendency to form blood clots, “he said. Today’s MedPage..

Large vessel occlusion of COVID-19 may be a direct sign of SARS-CoV-2-related hypercoagulability-suggested by elevated D-dimer-but significantly higher levels of biomarkers Different, patient, Perry and colleagues showed.

“COVID-19 does not appear to affect stroke by a single mechanism alone. As a single etiological category of ischemic stroke is more strongly associated with COVID-19 infection than others. I can’t see, “they wrote.

“COVID-19 suggests that it promotes thrombus formation through a variety of thrombotic and inflammatory mechanisms, or through small vessel occlusion, and can lead to the development of ischemic stroke. Which of these mechanisms may appear in a particular patient is determined by the individual Traditional vascular risk factors Atrial fibrillation, macrovascular atheroma, hypertension, type 2 diabetes, etc. “continued the study’s authors.

Perry’s group relied on a combination of retrospective and future data collection for research.

Early in the study period, SARS-CoV-2 testing was given to patients only when there was clinical suspicion of COVID-19. According to Perry and colleagues, the proportion of asymptomatic patients tested gradually increased from 10.3% to 93.5% during the week of March 9 to May 11, and then averaged 95.3% in the remaining studies. I stayed.

Eighty-six stroke patients were tested positive within 4 days of admission or onset of stroke. They were divided into 81 ischemic strokes and 5 intracerebral hemorrhage.

For comparison, Perry et al. Examined the records of 1,384 patients hospitalized during the same period. These patients were not tested because they were consistently negative for SARS-CoV-2 or showed no symptoms or signs of COVID-19. This group counted 1,193 ischemic strokes and 191 intracerebral hemorrhage.

Overall, the median age of the cohort was 73 years, with about 53% being male.

Unlike previous reports, stroke patients with SARS-CoV-2 infection were not likely to be young or male. Rather, COVID-19 patients who had a stroke were more likely to be Asian (18.8% vs. 6.7% in the non-COVID group). P<0.0001), Perry's team reported.

Recurrence of stroke during hospitalization of patients was similarly rare (2.3% vs. 1.0%) between cases of COVID and controls.

The authors of the study found that other large studies of COVID-19-related stroke used historical controls for comparison and overestimated the impact of COVID-19 on stroke severity and other parameters that correlate with severity. He said he biased the results towards evaluation.

Nonetheless, their own studies were also affected by the bias, given that some reports and tests were not available in all patients.

Case-control studies could not include all consecutive cases during the study period.

“Most centers did not expect to collect data on consecutive stroke hospitalizations throughout the study period, so the center prioritizes the weeks in which patients with COVID-19 were hospitalized and such weeks (Monday to Sunday). Includes all strokes, regardless of SARS-CoV-2 status, “said Perry’s group.

For now, the authors said that patients with other unexplained ischemic stroke and very high D-dimer should be tested for SARS-CoV-2 infection. They added that people who test positive for COVID-19 may benefit from CT angiography because of multiple findings. Large vascular occlusion Certain management strategies (ie, mechanical thrombectomy or another antithrombotic agent) may be required.

“On the other hand, in most patients with COVID-19-related ischemic stroke, very early anticoagulant therapy is probably not guaranteed as a strategy to prevent recurrence of stroke in inpatients. This result is rare. , Because it cannot justify the increased risk of secondary bleeding, “according to the group.

“Finally, less than 6% of the patients included in this report had COVID-19, but the disease affects people of all ages, so even young people know the symptoms of stroke and treat it immediately. It is important to note that we need to ask for. “Goldstein emphasized.