SARS-CoV-2 and Stroke in a New York Healthcare System

With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data o...

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Published in:	Stroke (1970) Vol. 51; no. 7; p. 2002
Main Authors:	Yaghi, Shadi, Ishida, Koto, Torres, Jose, Mac Grory, Brian, Raz, Eytan, Humbert, Kelley, Henninger, Nils, Trivedi, Tushar, Lillemoe, Kaitlyn, Alam, Shazia, Sanger, Matthew, Kim, Sun, Scher, Erica, Dehkharghani, Seena, Wachs, Michael, Tanweer, Omar, Volpicelli, Frank, Bosworth, Brian, Lord, Aaron, Frontera, Jennifer
Format:	Journal Article
Language:	English
Published:	United States 01.07.2020
Subjects:	Adult Aged Betacoronavirus Biomarkers Blood Sedimentation Brain Ischemia - blood Brain Ischemia - epidemiology Brain Ischemia - etiology Brain Ischemia - therapy Causality Cerebral Small Vessel Diseases - complications Cerebral Small Vessel Diseases - diagnostic imaging Cerebral Small Vessel Diseases - epidemiology Comorbidity Coronavirus Infections - blood Coronavirus Infections - complications Coronavirus Infections - epidemiology COVID-19 Female Fibrin Fibrinogen Degradation Products - analysis Humans Incidence Male Middle Aged Neuroimaging New York City - epidemiology Pandemics Patient Admission - statistics & numerical data Pneumonia, Viral - blood Pneumonia, Viral - complications Pneumonia, Viral - epidemiology Retrospective Studies SARS-CoV-2 Severity of Illness Index Stroke - blood Stroke - epidemiology Stroke - etiology Stroke - therapy Thrombophilia - etiology Troponin - blood New York City COVID-19 coronavirus diagnosis troponin pandemic
ISSN:	1524-4628, 1524-4628
Online Access:	Get more information
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Abstract	With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19. We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls). During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, =0.003) and historical controls (25.0%, <0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls. We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.
AbstractList	With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19.BACKGROUND AND PURPOSEWith the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19.We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls).METHODSWe conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls).During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls.RESULTSDuring the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls.We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.CONCLUSIONSWe observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19. With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19. We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls). During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, =0.003) and historical controls (25.0%, <0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls. We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.
Author	Humbert, Kelley Bosworth, Brian Ishida, Koto Alam, Shazia Volpicelli, Frank Kim, Sun Trivedi, Tushar Lillemoe, Kaitlyn Tanweer, Omar Mac Grory, Brian Yaghi, Shadi Lord, Aaron Torres, Jose Scher, Erica Frontera, Jennifer Sanger, Matthew Raz, Eytan Wachs, Michael Dehkharghani, Seena Henninger, Nils
Author_xml	– sequence: 1 givenname: Shadi surname: Yaghi fullname: Yaghi, Shadi organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 2 givenname: Koto surname: Ishida fullname: Ishida, Koto organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 3 givenname: Jose surname: Torres fullname: Torres, Jose organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 4 givenname: Brian surname: Mac Grory fullname: Mac Grory, Brian organization: Department of Neurology, Brown University, Providence, RI (B.M.G.) – sequence: 5 givenname: Eytan surname: Raz fullname: Raz, Eytan organization: Department of Radiology (E.R., S.D.), NYU Langone Health, New York, NY – sequence: 6 givenname: Kelley surname: Humbert fullname: Humbert, Kelley organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 7 givenname: Nils surname: Henninger fullname: Henninger, Nils organization: Department of Neurology, University of Massachusetts, Worcester (N.H.) – sequence: 8 givenname: Tushar surname: Trivedi fullname: Trivedi, Tushar organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 9 givenname: Kaitlyn surname: Lillemoe fullname: Lillemoe, Kaitlyn organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 10 givenname: Shazia surname: Alam fullname: Alam, Shazia organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 11 givenname: Matthew surname: Sanger fullname: Sanger, Matthew organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 12 givenname: Sun surname: Kim fullname: Kim, Sun organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 13 givenname: Erica surname: Scher fullname: Scher, Erica organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 14 givenname: Seena surname: Dehkharghani fullname: Dehkharghani, Seena organization: Department of Radiology (E.R., S.D.), NYU Langone Health, New York, NY – sequence: 15 givenname: Michael surname: Wachs fullname: Wachs, Michael organization: Department of Operational Projects and Analytics (M.W.), NYU Langone Health, New York, NY – sequence: 16 givenname: Omar surname: Tanweer fullname: Tanweer, Omar organization: Department of Neurosurgery (O.T.), NYU Langone Health, New York, NY – sequence: 17 givenname: Frank surname: Volpicelli fullname: Volpicelli, Frank organization: Department of Internal Medicine (F.V., B.B.), NYU Langone Health, New York, NY – sequence: 18 givenname: Brian surname: Bosworth fullname: Bosworth, Brian organization: Department of Internal Medicine (F.V., B.B.), NYU Langone Health, New York, NY – sequence: 19 givenname: Aaron surname: Lord fullname: Lord, Aaron organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY – sequence: 20 givenname: Jennifer surname: Frontera fullname: Frontera, Jennifer organization: Department of Neurology (S.Y., K.I., J.T., K.H., T.T., K.L., S.A., M.S., S.K., E.S., A.L., J.F.), NYU Langone Health, New York, NY
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PublicationTitle	Stroke (1970)
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References	32755453 - Stroke. 2020 Nov;51(11):e312-e313 33226920 - Stroke. 2020 Dec;51(12):e373-e374 32780387 - MMW Fortschr Med. 2020 Aug;162(14):29 33104463 - Stroke. 2020 Nov;51(11):e314-e315 32755455 - Stroke. 2020 Nov;51(11):e310-e311 33104484 - Stroke. 2020 Nov;51(11):e316-e317 32716821 - Stroke. 2020 Aug;51(8):e179 33226930 - Stroke. 2020 Dec;51(12):e371-e372 32496937 - Stroke. 2020 Jul;51(7):1924-1926
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Snippet	With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness...
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SubjectTerms	Adult Aged Betacoronavirus Biomarkers Blood Sedimentation Brain Ischemia - blood Brain Ischemia - epidemiology Brain Ischemia - etiology Brain Ischemia - therapy Causality Cerebral Small Vessel Diseases - complications Cerebral Small Vessel Diseases - diagnostic imaging Cerebral Small Vessel Diseases - epidemiology Comorbidity Coronavirus Infections - blood Coronavirus Infections - complications Coronavirus Infections - epidemiology COVID-19 Female Fibrin Fibrinogen Degradation Products - analysis Humans Incidence Male Middle Aged Neuroimaging New York City - epidemiology Pandemics Patient Admission - statistics & numerical data Pneumonia, Viral - blood Pneumonia, Viral - complications Pneumonia, Viral - epidemiology Retrospective Studies SARS-CoV-2 Severity of Illness Index Stroke - blood Stroke - epidemiology Stroke - etiology Stroke - therapy Thrombophilia - etiology Troponin - blood
Title	SARS-CoV-2 and Stroke in a New York Healthcare System
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