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Observational Study
. 2021 Jan;52(1):48-56.
doi: 10.1161/STROKEAHA.120.031668. Epub 2020 Dec 7.

Acute Cerebrovascular Events With COVID-19 Infection

Mandip S Dhamoon  1 , Alison Thaler  1 , Kapil Gururangan  1 , Amit Kohli  1 , Daniella Sisniega  1 , Danielle Wheelwright  1 , Connor Mensching  1 , Johanna T Fifi  1 , Michael G Fara  1 , Nathalie Jette  1 , Ella Cohen  1 , Priya Dave  1 , Aislyn C DiRisio  1 , Jonathan Goldstein  1 , Emma M Loebel  1 , Naomi A Mayman  1 , Akarsh Sharma  1 , Daniel S Thomas  1 , Ruben D Vega Perez  1 , Mark R Weingarten  1 , Huei Hsun Wen  1 , Stanley Tuhrim  1 , Laura K Stein  1 ; Mount Sinai Stroke Investigators*
Collaborators, Affiliations
Free article
Observational Study

Acute Cerebrovascular Events With COVID-19 Infection

Mandip S Dhamoon et al. Stroke. 2021 Jan.
Free article

Abstract

Background and purpose: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known.

Methods: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results.

Results: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P<0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (P=0.02), parietal (P=0.002), occipital (P=0.002), and cerebellar (P=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (P<0.0001), greater percentage requiring intensive care unit care (P=0.017), and greater rate of neurological worsening during admission (P<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P<0.0001).

Conclusions: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.

Keywords: epidemiology; incidence; intracerebral hemorrhage; ischemic stroke; length of stay; risk factors; subarachnoid hemorrhage.

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