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J Thromb Thrombolysis . COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature

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  • J Thromb Thrombolysis . COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature


    J Thromb Thrombolysis


    . 2020 Jul 13.
    doi: 10.1007/s11239-020-02228-y. Online ahead of print.
    COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature


    Ying-Kiat Tan 1 , Claire Goh 1 , Aloysius S T Leow 2 , Paul A Tambyah 1 3 , Alicia Ang 3 , Eng-Soo Yap 4 5 , Tian-Ming Tu 6 , Vijay K Sharma 1 2 , Leonard L L Yeo 7 8 , Bernard P L Chan 2 , Benjamin Y Q Tan 1 2



    Affiliations

    Abstract

    Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ? 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ? 8 days, and the mean NIHSS score was 19 ? 8. Laboratory investigations revealed an elevated mean D-dimer (9.2 ? 14.8 mg/L) and fibrinogen (5.8 ? 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated D-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis.

    Keywords: Antiphospholipid antibodies; COVID-19; Hypercoagulable; Ischemic stroke; Thrombosis.

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