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

Valencia-Enciso, Natalia; Pereira, Mónica Juliana Ortíz; Zafra-Sierra, María Paula; Espinel-Gómez, Laura; Bayona, Hernán

doi:10.1016/j.jstrokecerebrovasdis.2020.105325

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…Other studies corroborate the high incidence of cryptogenic stroke, with time to stroke ranging from 0 to 65 days after onset of symptoms. 24 In our study, all cerebrovascular events occurred at a mean 46 days after diagnosis of COVID-19.…”

Section: Discussionmentioning

confidence: 62%

Late thrombotic complications after SARS‐CoV‐2 infection in hemodialysis patients

Shabaka

Gruss

Landaluce-Triska

et al. 2021

Hemodialysis International

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Introduction There is an increased risk of thrombotic complications in patients with COVID‐19. Hemodialysis patients are already at an increased risk for thromboembolic events such as stroke and pulmonary embolism. The aim of our study was to determine the incidence of late thrombotic complications (deep vein thrombosis, pulmonary embolism, stroke, new‐onset vascular access thrombosis) in maintenance hemodialysis patients after recovery from COVID‐19. Methods We performed a retrospective cohort study of 200 prevalent hemodialysis patients in our center at the start of the pandemic. We excluded incident patients after the cohort entry date and those who required hemodialysis for acute kidney injury, and excluded patients with less than 1 month follow‐up due to kidney transplantation or death from non‐thrombotic causes. Findings One‐hundred and eighty five prevalent hemodialysis patients finally met the inclusion criteria; 37 patients (17.6%) had SARS‐CoV‐2 infection, out of which 10 (27%) died during the acute phase of disease without evidence of thrombotic events. There was an increased risk of thrombotic events in COVID‐19 survivors compared to the non‐infected cohort (18.5% vs. 1.9%, p = 0.002) after a median follow‐up of 7 months. Multivariate regression analysis showed that COVID‐19 infection increased risk for late thrombotic events adjusted for age, sex, hypertension, diabetes, antithrombotic treatment, and previous thrombotic events (Odds Ratio (OR) 26.4, 95% confidence interval 2.5–280.6, p = 0.01). Clinical and laboratory markers did not predict thrombotic events. Conclusions There is an increased risk of late thrombotic complications in hemodialysis patients after infection with COVID‐19. Further studies should evaluate the benefit of prolonged prophylactic anticoagulation in hemodialysis patients after recovery from COVID‐19.

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Section: Discussionmentioning

confidence: 62%

Late thrombotic complications after SARS‐CoV‐2 infection in hemodialysis patients

Shabaka

Gruss

Landaluce-Triska

et al. 2021

Hemodialysis International

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“…Multiple studies suggest that pro-inflammatory markers associated with COVID-19 infection, including D-dimer, IL-6, ferritin, and fibrinogen, may contribute to an inflammatory process mediating cerebrovascular accidents. One study found correlations with large vessel thrombosis and anterior circulation strokes[ 60 ], but more data and institutional collaboration of information are needed to understand the significance of the anatomic locality of strokes associated with COVID-19 infection. This multi-centered approach may elucidate future guidelines for certain patients, risk factors, or clinical findings unique to COVID-19 patients with neurologic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Current systematic reviews and meta-analyses of COVID-19

Nassar¹,

Nso²,

Alfishawy³

et al. 2021

WJV

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BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life. AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed. METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain. RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health , smoking, cancer, and transplant. CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.

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“…Our patient experienced his stroke within the 9-day period, from onset of COVID symptoms, that some authors described. 7 - 9 Other authors have reported large-vessel stroke in young COVID patients with limited risk factors; however, the stroke usually occurred at the onset of COVID illness before patients presented to the hospital and involved one vascular territory. 8 Malignant edema has complicated stroke in other patients, at times requiring hemicraniectomy, 9 but this occurred again with unilateral infarcts.…”

Section: Discussionmentioning

confidence: 99%

Massive Ischemic Strokes in a Young Patient With Severe Coronavirus Disease 2019 Pneumonia

Achebe

Nagubadi

Pierre-Louis

2021

Journal of Investigative Medicine High Impact Case Reports

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Stroke is an identified sequela of severe coronavirus disease 2019 (COVID-19) infection. While the pathophysiology remains poorly understood, endothelial dysfunction and intravascular thrombosis secondary to sepsis-induced hypercoagulability likely increase the risk of stroke. This report describes the rare case of an otherwise healthy 42-year-old male who developed large bilateral ischemic infarcts during admission for severe hypoxemic respiratory failure secondary to COVID pneumonia. This report adds to scarce literature describing massive cerebrovascular injury in COVID patients and emphasizes the importance of increased clinical suspicion for stroke in patients who exhibit acute change in mental status or motor function, as well as rapid clinical deterioration.

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

Cited by 11 publications

References 30 publications

Late thrombotic complications after SARS‐CoV‐2 infection in hemodialysis patients

Late thrombotic complications after SARS‐CoV‐2 infection in hemodialysis patients

Current systematic reviews and meta-analyses of COVID-19

Massive Ischemic Strokes in a Young Patient With Severe Coronavirus Disease 2019 Pneumonia

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