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. 2021 Aug;30(8):105919.
doi: 10.1016/j.jstrokecerebrovasdis.2021.105919. Epub 2021 Jun 1.

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

Mehmet Akif Topcuoglu  1 , Mehmet Yasir Pektezel  2 , Dogan Dinç Oge  2 , Nihal Deniz Bulut Yüksel  3 , Cansu Ayvacioglu  2 , Ezgi Demirel  2 , Sinan Balci  3 , Anil Arat  3 , Seda Banu Akinci  4 , Ethem Murat Arsava  2
Affiliations

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

Mehmet Akif Topcuoglu et al. J Stroke Cerebrovasc Dis. 2021 Aug.

Abstract

Background: The characteristics and pathophysiological mechanisms involved in acute ischemic stroke in patients with COVID-19 infection have not been fully clarified. We prospectively studied the phenotypic and etiological features of acute stroke occurring in COVID-19 infection.

Patients & methods: Within nine months starting from April-2020, the presence of COVID-19 infection was determined by thoracic CT and SARS-CoV-2 PCR in all acute stroke cases managed in a single tertiary center. Consecutive and prospective data on vascular risk factors/comorbidities, in-hospital quality metrics, discharge outcomes, etiological subclassification and blood markers of thrombosis / inflammation were compared in 44 COVID-19 positive cases (37 acute ischemic stroke, 5 TIA, 2 intracerebral hematoma) and 509 COVID-19 negative patients (355 ischemic, 105 TIA, 44 hematoma and 5 stroke mimic).

Results: COVID-19 positive patients had more severe strokes, delayed hospital admission, longer hospital stay, higher mortality rates, but had similar vascular risk factors/comorbidities frequency, thrombolysis/thrombectomy utilization rates, metrics, and stroke etiological subtype. They had significantly higher CRP, fibrinogen, ferritin, leukocyte count and lower lymphocyte count. No difference was detected in aPTT, INR, D-dimer, platelet, hemoglobin, homocysteine levels and ANA, anti-dsDNA antibody and ENA panel positivity rates. Anti-phospholipid antibodies have been studied in 70% of COVID-19 positive and all cryptogenic patients, but were never found positive. Tests for coagulation factor levels and hereditary thrombophilia did not show major thrombophilia in any of the stroke patients with COVID-19.

Conclusion: We documented that there is no significant difference in etiological spectrum in acute stroke patients with COVID-19 infection. In addition, cryptogenic stroke and antiphospholipid antibody positivity rates did not increase.

Keywords: Anticoagulation; COVID-19; Intracerebral hemorrhage; Stroke; Transient ischemic attack; Viral pneumonia.

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Conflict of interest statement

Declaration of Competing Interest None.

References

    1. Logroscino G, Beghi E. Stroke epidemiology and COVID-19 pandemic. Curr Opin Neurol. 2021;34:3–10. - PubMed
    1. Tsivgoulis G, Palaiodimou L, Zand R, Lioutas VA, Krogias C, Katsanos AH, et al. COVID-19 and cerebrovascular diseases: a comprehensive overview. Ther Adv Neurol Disord. 2020;13 - PMC - PubMed
    1. Topcuoglu MA, Arsava EM, Kursun O, Akpinar E, Erbil B. The utility of middle cerebral artery clot density and burden assessment by noncontrast computed tomography in acute ischemic stroke patients treated with thrombolysis. J Stroke Cerebrovasc Dis. 2014;23:e85–e91. - PubMed
    1. WHO-working-group-on-the-clinical-characterisation-management-of-covid-infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020;20:e192–e1e7. - PMC - PubMed
    1. Topcuoglu M, Arsava E, Özdemir A. COVID-19 pandemisinde akut iskemik inme tedavisi: uzman görüşü (in English: Acute ischemic stroke treatment in COVID-19 pandemia: Expert Opinion) Türk Beyin Damar Hastalıkları Dergisi. 2020;26:81–84.

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