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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Bibliographic Details
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
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Summary: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.
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ISSN:1524-4628
1524-4628
DOI:10.1161/STROKEAHA.120.030335