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Published on: June 18, 2021
Acute Cerebrovascular Events in Hospitalized COVID-19 Patients
Aaron Rothstein1, Olivia Oldridge1, Hannah Schwennesen1
1Department of Neurology, University of Pennsylvania, Philadelphia.
Insights
This study found a low incidence of stroke in hospitalized coronavirus disease 2019 (COVID-19) patients. Most strokes were linked to traditional risk factors and common mechanisms, not solely COVID-19.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Initial reports indicated a heightened risk of thrombotic events, including stroke, in patients with coronavirus disease 2019 (COVID-19).
- Limited systematic data exists on stroke incidence and mechanisms, particularly within diverse U.S. populations.
- Understanding stroke risk in COVID-19 is crucial for patient management and public health strategies.
Purpose of the Study:
- To investigate the incidence and mechanisms of stroke in hospitalized patients with COVID-19.
- To analyze stroke characteristics in a racially diverse patient cohort.
- To identify potential risk factors and stroke etiologies associated with COVID-19 hospitalization.
Main Methods:
- A retrospective, observational study was conducted.
- Data was collected from 844 hospitalized COVID-19 patients across three Philadelphia hospitals between March 15 and May 3, 2020.
- Stroke incidence, mechanisms, patient demographics, and vascular risk factors were analyzed.
Main Results:
- 2.4% of COVID-19 patients experienced ischemic stroke, and 0.9% had intracranial hemorrhage.
- The majority of ischemic stroke patients were Black, older, and had pre-existing hypertension and diabetes.
- Newly positive antiphospholipid antibodies were observed in over 75% of tested patients; cardioembolism was the most common stroke mechanism.
Conclusions:
- The risk of acute cerebrovascular events in hospitalized COVID-19 patients was found to be low.
- Conventional vascular risk factors and traditional stroke mechanisms predominated in patients who experienced stroke.
- Further research is needed to fully elucidate the complex relationship between COVID-19 and cerebrovascular events.
Background And Purpose:
Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States.
Methods:
We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals.
Results:
We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation.
Conclusions:
We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.
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