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Acute Cerebrovascular Events With COVID-19 Infection

2020; Lippincott Williams & Wilkins; Volume: 52; Issue: 1 Linguagem: Inglês

10.1161/strokeaha.120.031668

1524-4628

Mandip S. Dhamoon, Alison Thaler, Kapil Gururangan, Amit Kohli, Daniella Sisniega, Danielle Wheelwright, Connor Mensching, Johanna T Fifi, Michael Fara, Nathalie Jetté, Ella Cohen, Priya Dave, Aislyn C. DiRisio, Jonathan Goldstein, Emma Loebel, Naomi Mayman, Akarsh Sharma, Daniel Thomas, Ruben Vega Perez, Mark Weingarten, Huei Hsun Wen, Stanley Tuhrim, Laura Stein, Jesse Weinberger, Deborah Horowitz, Kara Sheinart, Benjamin Kummer, Qing Hao, Tara Roche, Mahalet Gizaw, Kamil Stefanowski, Vaibhav Goswami, J Mocco, Thomas J. Oxley, Shahram Majidi, Inder Paul Singh, Hazem Shoirah, Reade De Leacy, Christopher P. Kellner, Tomoyoshi Shimegatsu, Benjamin Yim, Travis R. Ladner, Kurt Yaeger, Maryna Skliut, Irene Boniece, Carolyn Brockington, Punam Dass, E. John Nasrallah, Steven Rudolph, Holly Morhaim, John Liang, Alexandra S. Reynolds, Neha Dengayach, Cappi Lay, Kate Reilly, Helen Cheung, Daniel Chiu, Veronica J. Peschansky, Sarah Levy, John Erdman, Rebecca M. Baron, Daniel Charytonowicz, Caroline Gentile, Marcia Lange, Jacob Lurie, Rio O’Mary, Akila Pai, Dahniel Sastow, Himanshu Sharma, Charlotte Solmssen, Ruben Vega Perez,

COVID-19 and healthcare impacts

Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known.We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results.Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P<0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (P=0.02), parietal (P=0.002), occipital (P=0.002), and cerebellar (P=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (P<0.0001), greater percentage requiring intensive care unit care (P=0.017), and greater rate of neurological worsening during admission (P<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P<0.0001).Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.