There is no positive association between ischemic stroke and Coronavirus Disease 2019 (COVID-19). However, patients with stroke and COVID-19 had worse outcomes and higher mortality rates than patients without a cross-sectional, multicenter study published in Stroke.
More recently, it has been speculated that COVID-19 is associated with an increased risk of fatal ischemic stroke in young adults, which is touted by a procoagulable state in infected patients. However, other reports have pointed to a reduced incidence of ischemic stroke due to the COVID-19 pandemic. To examine the link between COVID-19 and ischemic stroke, investigators used discharge data from 6 hospitals in New York, all of which are comprehensive centers and 5 advanced primary stroke centers. A total of 24,808 patients were included in the analysis between January and April. A logistic regression analysis with mixed effects and an analysis weighted with the propensity score were used to check for confounding factors and to demonstrate the influence of a simultaneous COVID-19 infection on unfavorable outcomes in patients with stroke.
Of 2513 patients (10.1%) identified and diagnosed with COVID-19, 55.8% were men and the mean age was 72.7 years. There were 566 patients with COVID-19 who had an acute ischemic stroke; 53.5% were female with a mean age of 72.7 years.
The results suggest that there is no positive association between ischemic stroke and COVID-19. The likelihood of ischemic stroke in patients with COVID-19 was 0.35 times lower (95% CI, 0.23-0.55) than in patients without COVID-19. After checking patient characteristics and comorbidities, the researchers used logistic regression with facility-fixed effects and calculated that the likelihood of stroke in patients with COVID-19 was 0.25 times lower (95% CI, 0.16-0.40; P <0.001) in patients without COVID-19. Additionally, this lack of association persisted when ischemic stroke (OR 0.29; 95% CI 0.18-0.48; P <0.001) and transient ischemic attacks (OR 0.14; 95% CI 0.10- 0.38; P <0.001) were analyzed separately.
In patients with acute ischemic stroke, concomitant severe infection with the coronavirus 2 (SARS-CoV-2) with acute respiratory syndrome was associated with a 9-fold increase in mortality compared to patients without concomitant SARS-CoV-2 (31.8 % versus 4.6)%; OR 10.50; 95% CI 3.54-31.18; P <0.001).
A limitation of this study is the lack of hospital stays and long-term data on the analyzed patients. In addition, strokes were not divided into subtypes. Therefore, there is a possibility that a cause of stroke may be more common in patients diagnosed with COVID-19.
The researchers “did not see a positive association between COVID-19 and ischemic stroke,” possibly due to patient anxiety about being exposed to SARS-CoV-2 in emergency rooms. “Although final conclusions cannot be drawn from our observational study, our data do not support concerns about a stroke epidemic in young adults with COVID-19,” concluded the study authors.
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Bekelis K., Missios S., Ahmad J. et al. Ischemic stroke is less common in patients with COVID-19: a multicenter cross-sectional study. Stroke. Published online October 27, 2020. doi: 10.1161 / STROKEAHA.120.031217.
This article originally appeared on Infectious Disease Advisor