Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry

Abstract

Background and purpose Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. Methods We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20–6/16/20). Results Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41–18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35–3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02–1.21, p = 0.01) were also independently predictive of mortality. Conclusions Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.

Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

“…Early in the pandemic, there were many concerns regarding hemorrhagic manifestations of disseminated intravascular coagulation ( 10 ); but further experience suggests hypercoagulopathy is a greater concern with increased thrombogenicity and fibrinolysis resistance (IV-tPA failure because of resistance or recurrent thrombosis) ( 11 ). In the current study, large-artery atherosclerosis was a major cause of stroke in all cases, particularly in those with COVID-19, which is in contrast with other series where cryptogenic stroke was the most common mechanism of stroke among COVID-19 patients ( 19 , 20 ). This may indicate a possibility of increased thrombogenicity in those with COVID-19 and stroke.…”

Stroke Mechanism in COVID-19 Infection: A Prospective Case-Control Study

“…Our cryptogenic stroke rate was approximately one-fifth, but rates of up to two-thirds were reported in the literature. 13 , 15 The reason for this excess may be the possibility of COVID-19-specific stroke, as well as the inability to transfer from the ICU to examination suites due to the severity of the pulmonary disease, or the refusal to perform close contact tests such as transthoracic echocardiography. In our study, the rate of transthoracic echocardiography was also low, but this was compensated by long-term bedside cardiac monitoring and at least one cervicocranial angiography for each patient.…”

Unusual Presentation of a Severe COVID-19 Case With Axillary Artery Thrombosis

“…The main risk factor for DVT in ICU was linked to immobility leading to blood stagnation, which has been tremendously reduced by DVT pharmacoprophylaxis. On the other hand, idiopathic arterial thrombosis is not frequent in a critical care setting as the mechanisms are a bit different than that of the venous ones and are usually iatrogenic or associated with invasive procedures [12,13]; arterial blood flow is usually fast and does not give chance for clot formation like venous ones [8,14,15]. Thrombosis in COVID-19 disease has been linked to multiple mechanisms, including endothelial cell damage through binding of viral spike protein to the angiotensin-converting enzyme 2 (ACE-2) receptor that is expressed mainly in the heart, lung, and intestine, and also found on the endothelium of all blood vessels.…”