Abstract P87: Time of Stroke Onset in Coronavirus Disease 2019 Patients Around the Globe: A Systematic Review and Analysis

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) has been associated with stroke, particular characteristics of these patients are not fully understood. The adequate management of these patients depends on the comprehension of factors such as temporality, clinical presentation and etiology. We hypothesize there is a differential temporal relationship between COVID-19 severity and stroke onset. Methods: Considering PRISMA guidelines, a systematic review of the literature as of July 2020 was conducted and registered on PROSPERO. Pubmed and Scopus studies reporting patients with COVID-19 and stroke were included. Clinical, sociodemographic and laboratory characteristics of patients were extracted and analyzed. Results: Forty-seven studies and 176 patients were included, with a mean age of 63.1 years (SD= 16 n=122), most of them were males (63.2% n=171). The most frequent etiology was cryptogenic (40.9% n=66), and a mean National Institute of Health Stroke Scale of 14.4 points was found (SD= 8.6 n=73). Large vessel occlusion (LVO) was reported in 65.9% patients (n=91) and these patients were younger with greater stroke severity. D-dimer, C-reactive protein, fibrinogen, ferritin and lactate dehydrogenase were elevated in most patients with reported findings. Most patients had severe COVID-19. The mean time from onset of respiratory symptoms to stroke was 9 days (SD=9.9), a shorter time was noted in those with mild and moderate disease compared with the longest time in severe disease, this difference was statistically significant (p< 0.001). Conclusions: There is a trend between the severity of COVID-19 and time to stroke onset, in which mild disease is associated with earlier stroke than severe disease. Age and stroke severity are related to the development of LVO. Inflammation and hypercoagulability markers are elevated in this disease, we propose to consider hypercoagulability secondary to COVID-19 as an underlying cause of stroke in these patients.