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Correlation Between Hypercoagulable State and Severity Level of Ischemic Stroke With Covid-19 Infection
1Department of Neurology, Medical Faculty, Universitas Padjadjaran, Bandung, Indonesia.
Insights
COVID-19 patients with acute ischemic stroke often develop a hypercoagulable state, increasing mortality risk. While not linked to initial stroke severity, it correlates with worse outcomes at discharge.
Area of Science:
- Neurology
- Infectious Diseases
- Hematology
Background:
- COVID-19 is associated with a hypercoagulable state in most acute ischemic stroke patients.
- This hypercoagulable state may influence the severity and clinical outcomes of these patients.
- Ischemic stroke patients with COVID-19 infection exhibit a poorer prognosis, particularly concerning mortality, when a hypercoagulable state is present.
Purpose of the Study:
- To investigate the relationship between a hypercoagulable state and the severity of acute ischemic stroke in patients with COVID-19.
Main Methods:
- Retrospective, cross-sectional analytic study.
- Included patients with acute ischemic stroke, confirmed COVID-19, and D-dimer/fibrinogen levels.
- Analyzed data using Chi-Square test for relationship analysis.
Main Results:
- 87.5% of patients (28/32) exhibited a hypercoagulable state (elevated D-dimer/fibrinogen).
- No significant relationship was found between hypercoagulable state and stroke severity on admission (NIHSS admission).
- A significant relationship was observed between hypercoagulable state and stroke severity at discharge (NIHSS exit, p=0.02), and a high mortality rate (40.62%) was noted in patients with a hypercoagulable state.
Conclusions:
- The hypercoagulable state in acute ischemic stroke patients with COVID-19 is not significantly related to initial stroke severity.
- However, it is closely related to neurological status at discharge and is associated with increased mortality.
- These findings highlight the importance of monitoring hypercoagulability in COVID-19 stroke patients for improved clinical management and outcomes.
Background:
Hypercoagulable state in acute ischemic stroke patients with COVID-19, was found to occur in most cases, may affect the severity and clinical outcome of acute ischemic stroke with COVID-19. Ischemic stroke patients with COVID-19 infection have worsen prognosis in mortality regarding hypercoagulable state condition.
Objective:
The study aims to determine the relationship between the hypercoagulable state and the severity of acute ischemic stroke patients with COVID-19.
Methods:
This study is a retrospective analytic study using a cross-sectional method in acute ischemic stroke who meet the criteria must have focal clinical symptoms or global dysfunction lasting more than 24 hours, be caused by vascular factors, be confirmed positive for COVID-19, NIHSS (admission and discharge), and have an examination of D-dimer and/or fibrinogen. Chi-Square is used for data processing relationship analysis.
Results:
A total of 32 patients met the inclusion and exclusion criteria of this study. Elevated D-dimer and/or fibrinogen were found in 28 patients (87.5%), confirming a hypercoagulable state. In this study, the average value of D-dimer was 5.3 mg/mL, and fibrinogen was 479 mg/dL. Based on the admission NIHSS score, it was found that most of the patients had moderate strokes with an average NIHSS score of 12. The chi-square test results showed no relationship between the hypercoagulable state and the severity of acute ischemic stroke as measured by NIHSS admission (p=0.333), but it was closely related to NIHSS exit (p=0.02). The finding supports that 40.62% of acute ischemic stroke patients with COVID-19 confirmed to have a hypercoagulable state had a death discharge status.
Conclusion:
There is no significant relationship between hypercoagulable state and stroke severity on admission, but it closely related to NIHSS on discharge and high mortality in acute ischemic stroke patients with COVID-19.
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