Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors

Siow, Isabel; Lee, Keng Siang; Zhang, John J.Y.; Saffari, Seyed Ehsan; Ng, Adeline Su Lyn; Young, Barnaby Edward

doi:10.1016/j.jstrokecerebrovasdis.2020.105549

Cited by 97 publications

(101 citation statements)

References 49 publications

(71 reference statements)

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“…Patients hospitalized for stroke with an associated diagnosis of CO-VID-19 (group C) had also a higher inhospital case-fatality rate than patients hospitalized for stroke without COVID-19, although they had lower inhospital case-fatality rates than patients hospitalized for stroke with a primary diagnosis of COVID-19 (group B). This suggested the higher severity of COVID-19-associated stroke found in previous studies [2,14,15]. However, we lacked clinical data to assess properly stroke severity.…”

Section: Discussionmentioning

confidence: 79%

Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

et al. 2021

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Introduction: COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of COVID-19 at a nationwide scale. Methods: This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (Programme de Médicalisation des Systèmes d’Information, included in the Système National des Données de Santé). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. Results: Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without COVID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. Conclusion: Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.

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Section: Discussionmentioning

confidence: 79%

Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

et al. 2021

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“…Thrombosis associated with COVID-19, whether venous or arterial, has been associated in multiple studies with increased adverse outcomes [ 10 , 21 ]. Still, studies reporting its effect on mortality are limited.…”

Section: Discussionmentioning

confidence: 99%

“…The disease has been associated with an increased risk of venous and arterial thrombosis in multiple studies [2,3], ranging from 4% up to 60%. The highest incidence rates were reported involving deep vein thrombosis (DVT) and pulmonary embolism (PE) more than arterial thrombosis and mostly in critically ill patients [4][5][6][7], while arterial thrombosis events that have been described were ischemic strokes, limb ischemia, mesenteric ischemia, and others [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Unusual Presentation of a Severe COVID-19 Case With Axillary Artery Thrombosis

Aljamaan¹

2021

Cureus

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The coronavirus disease 2019 (COVID-19) pandemic has been evolving since early 2020 with high critical care mortality and morbidity. High mortality rates have been linked largely to respiratory failure. Hypercoagulability status induced by the massive inflammatory storm has led to a high rate of thrombotic events, whether arterial or venous, contributing to COVID-19 mortality especially in critically ill patients. Thrombotic events might be the presenting feature of the disease or might happen during hospitalization. In this case report, we describe a case of a 67-year-old male with severe COVID-19 pneumonia who was found on presentation to have left axillary artery thrombosis requiring embolectomy; the case was managed successfully. We reviewed the pathophysiology of hypercoagulability associated with COVID-19, clinical implications, and most recent treatment recommendations.

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“…Ein erhöhtes Schlaganfallrisiko bei schwer erkrankten COVID-19-Patienten/ innen fand sich dabei, unabhängig davon, ob die Erkrankungsschwere durch klinische Verlaufsparameter, die Notwendigkeit intensivmedizinischer Therapie oder durch ein kombiniertes Outcome definiert wurde, welches sämtliche von den Autoren der extrahierten Arbeiten festgelegten Schwerekriterien subsumierte. Eine weitere Meta-Analyse mit gepoolten Daten von insgesamt 55 176 COVID-19-Patienten/innen, von denen 899 einen Schlaganfall erlitten, bestätigte den Zusammenhang zwischen einem weiteren Anstieg des Schlaganfallrisikos mit dem Alter und der Schwere der COVID-19-Erkrankung [8].…”

Section: Klinische Evidenz Zur Durch Covid-19 Bedingten Risikoerhöhung Für Das Auftreten Eines Schlaganfallsunclassified

Der Zusammenhang zwischen COVID-19 und Schlaganfall: Pathophysiologie und klinische Bedeutung

Siepmann

Barlinn

2021

Fortschr Neurol Psychiatr

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ZusammenfassungDass COVID-19 mit einem erhöhten Risiko für das Auftreten ischämischer Schlaganfälle einhergeht, wurde bereits in den ersten Monaten nach dem weltweiten Bekanntwerden des Ausbruchs der Pandemie im Ground Zero Wuhan deutlich. Spätere Kohortenanalysen, Fallserien und Meta-Analysen bestätigten diesen Zusammenhang. Eine nicht unerhebliche geographische Variabilität der Prävalenz COVID-19-bezogener Schlaganfälle verdeutlicht allerdings den fortbestehenden Bedarf an umfassenden epidemiologischen Analysen. Im Übrigen fanden sich zunehmend Hinweise dafür, dass dem mit COVID-19 assoziierten Schlaganfall ein multifaktorieller pathophysiologischer Mechanismus zugrundeliegenden könnte. Neben einer durch die SARS-CoV-2-Infektion verursachten Hyperkoagubilität, die sowohl im mikrovaskulären System als auch in Großgefäßen thrombogen wirkt, scheinen vaskulitische arterielle Veränderungen und kardiogene Embolien infolge virusassoziierter myokardialer Schädigung bei der Ätiologie des COVID-19-assoziierten Schlaganfalls eine Rolle zu spielen. Die Versorgung von Schlaganfallpatienten/innen in Zeiten der Pandemie durch multidisziplinäre Teams scheint in insgesamt kompensierten Kliniken im Wesentlichen nicht kompromittiert zu sein. Hinweise, dass Patienten/innen mit COVID-19-assoziiertem Schlaganfall von einem intensivierten Monitoring und einer aggressiveren Sekundärprävention profitieren, bedarf klinischer Prüfung.

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Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors

Cited by 97 publications

References 49 publications

Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

Unusual Presentation of a Severe COVID-19 Case With Axillary Artery Thrombosis

Der Zusammenhang zwischen COVID-19 und Schlaganfall: Pathophysiologie und klinische Bedeutung

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