Neurological

Increased stroke risk in younger adults during recovery from COVID-19

Younger adults with asymptomatic or minimally symptomatic COVID-19 have an increased risk of acute ischemic stroke (AIS) during the convalescence phase of infection, according to study results published in JAMA Network Open.

Previous studies have shown that patients with respiratory symptoms of COVID-19 infection are at increased risk for AIS as a result of associated coagulopathy. However, there are limited data on the risk of AIS in asymptomatic or minimally symptomatic patients with COVID-19 infection.

The aim of the current study was to investigate the AIS risk in patients aged no more than 50 in the convalescence phase of an asymptomatic COVID-19 infection.

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The study’s researchers collected data on 54,485 patients from India and Bangladesh who worked and lived in dormitories in Singapore and had laboratory-confirmed asymptomatic COVID-19 infection.

Of the entire cohort, 18 men (mean age 41 years) were treated with AIS between May 21, 2020 and October 14, 2020. All patients had no respiratory symptoms due to AIS during their hospital stay and were negative for COVID-19 on swab tests. The median time from the positive serological result to the AIS was 54.5 days.

The study researchers identified large vessel occlusion on initial computed tomography or magnetic resonance imaging in 10 patients (56%), including 6 patients undergoing intravenous thrombolysis and / or endovascular therapy. A comprehensive investigation for possible causes revealed a cardiogenic cause of stroke in 3 patients.

The incidence rate was based on the 18 patients with AIS and a population at risk of 54,485 adults with COVID-19 over a period of 21 weeks. The results showed that the annual incidence rate of AIS was 82.6 cases per 100,000 adults. The historical age, gender, and ethnicity matched incidence rate of AIS was 38.2 cases per 100,000 adults. Therefore, the annual incidence rate of AIS in patients with asymptomatic COVID-19 patients was more than double that of the historical controls (rate ratio 2.16; 95% CI 1.36-3.48; P <0.001).

The study had several limitations, including the observational design, the sample limited to South Asian men, and the annual incidence rate, which is based on each case series and requires careful interpretation.

“The results indicate an increased risk of AIS for these patients months after a serological diagnosis. Stroke may be the next wave of complications from COVID-19. Therefore, stroke units should be on alert and perform serological tests, especially in younger patients or without traditional risk factors, ”the study’s researchers concluded.

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.

reference

Tu TM, Seet CYH, Koh JS et al. Acute ischemic stroke during the convalescence phase of asymptomatic COVID-2019 infection in men. JAMA Netw Open. Published online April 22, 2021. doi: 10.1001 / jamanetworkopen.2021.7498

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