JAMA Neurology (07/02/20) doi: 10.1001/jamaneurol.2020.2730
Merkler, Alexander E.; Parikh, Neal S.; Saad Mir; et al
Patients with COVID-19 may be at increased risk for risk for stroke compared with patients with influenza, according to a retrospective cohort study from New York–Presbyterian Hospital and Weill Cornell Medicine, both in New York City. “These findings suggest that clinicians should be vigilant for symptoms and signs of acute ischemic stroke in patients with COVID-19 so that time-sensitive interventions, such as thrombolysis and thrombectomy, can be instituted if possible to reduce the burden of long-term disability,” the researchers conclude. The study included adult patients who visited the emergency department (ED) or were hospitalized with COVID-19 between March 4 and May 2, 2020, and a comparison cohort of adults who visited the ED or were hospitalized with influenza A/B from Jan. 1, 2016 through May 31, 2018. Overall, 1.6% (31 patients) of the 1,916 patients with COVID-19 had an acute ischemic stroke. Of those patients, for whom the median age was 69 years, 26% (8) presented with stroke symptoms, while 74% (23) experienced an acute ischemic stroke while hospitalized. However, only 0.2% (3) of the 1,486 patients with influenza had an acute ischemic stroke. The risk of stroke was greater with COVID-19 compared with influenza after adjusting for age, sex, and race, and that association “persisted across multiple sensitivity analyses, with the magnitude of relative associations ranging from 4.0 to 9.3,” the researchers report. Further investigation is needed to confirm the results and to study possible thrombotic mechanisms in patients with COVID-19.