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. 2020 Jun;11(3):322-325.
doi: 10.1007/s12975-020-00818-9. Epub 2020 May 7.

COVID-19-Related Stroke

David C Hess  1 , Wael Eldahshan  2 , Elizabeth Rutkowski  3
Affiliations

COVID-19-Related Stroke

David C Hess et al. Transl Stroke Res. 2020 Jun.

Abstract

The COVID-19 pandemic is associated with neurological symptoms and complications including stroke. There is hypercoagulability associated with COVID-19 that is likely a "sepsis-induced coagulopathy" and may predispose to stroke. The SARS-CoV-2 virus binds to angiotensin-converting enzyme 2 (ACE2) present on brain endothelial and smooth muscle cells. ACE2 is a key part of the renin angiotensin system (RAS) and a counterbalance to angiotensin-converting enzyme 1 (ACE1) and angiotensin II. Angiotensin II is proinflammatory, is vasoconstrictive, and promotes organ damage. Depletion of ACE2 by SARS-CoV-2 may tip the balance in favor of the "harmful" ACE1/angiotensin II axis and promote tissue injury including stroke. There is a rationale to continue to treat with tissue plasminogen activator for COVID-19-related stroke and low molecular weight heparinoids may reduce thrombosis and mortality in sepsis-induced coagulopathy.

Keywords: Angiotensin-converting enzyme 2 (ACE2); COVID-19; Coagulopathy; SARS-CoV-2; Sepsis; Stroke.

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Conflict of interest statement

David C Hess MD is a consultant for Aruna Bio, Inc and receives fees for consultation and receives royalty payments from Athersys, Inc. Wael Eldahsahn PhD has no conflicts of interest/competing interests. Elizabeth Rutkowski has no conflicts of interest/competing interests.

Figures

Fig. 1
Fig. 1
ACE2 is expressed in human brain endothelium. SARS-CoV-2 binds ACE2, depleting ACE2 on the endothelium
See this image and copyright information in PMC

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References

    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed
    1. Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. SSRN Electron J. 2020. 10.2139/ssrn.3544840.
    1. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020. 10.1111/jth.14817. - PMC - PubMed
    1. Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, Levi M. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost. 2019;17(11):1989–1994. doi: 10.1111/jth.14578. - DOI - PubMed
    1. Wang J, Hajizadeh N, Moore EE, McIntyre RC, Moore PK, Veress LA, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): a case series. J Thromb Haemost. April 2020. 10.1111/jth.14828. - PMC - PubMed

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