The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐analysis

You don't want any of this to happen so as soon as you are diagnosed get heparin going. I'm not medically trained but due to the research I'm reading I'm doing heparin.

Why I'm getting heparin.  Heparin binds to cells at a site adjacent to ACE2, the portal for SARS-CoV-2 infection, and "potently" blocks the virus, which could open up therapy options.

Anticoagulation Again Shown to Improve Survival in COVID-19 Patients;-Mortality risk about 50% lower

But this research below suggests not due to bleeding risks. I'll take that risk since I've been on warfarin, aspirin and had Lovenox shots. 

COVID-Related Strokes Especially Severe, Result in Worse Outcomes

The paragraph from there:

"On the other hand, in most patients with COVID-19 associated ischaemic stroke, very early anti-coagulation is probably not warranted as a strategy to prevent inpatient stroke recurrence, as this outcome is too uncommon to justify the increased risk of secondary haemorrhage," according to the group.(So you wait until the clots are severe before you do anti-coagulation. OK, not for me.)

You doctor better know the EXACT PROTOCOL to prevent these complications.

The latest here:

The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐analysis

Aristeidis H. Katsanos MD

Lina Palaiodimou MD

Ramin Zand MD

Shadi Yaghi MD

Hooman Kamel MD

Babak B. Navi MD, MS

Guillaume Turc MD

Michele Romoli MD

… See all authors

First published: 21 November 2020

https://doi.org/10.1002/ana.25967

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.25967.

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Abstract

Objective

Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus and highlights the potential impact of coronavirus disease (COVID‐19) on the management and outcomes of acute stroke. We conducteda systematic review and meta‐analysis to evaluate the aforementioned considerations.

Methods

We performed a meta‐analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS‐CoV‐2 infection status. We used a random‐effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI).

Results

We identified 18 cohort studies including 67,845 patients. Among patients with SARS‐CoV‐2, 1.3% (95%CI:0.9‐1.6%;I²=87%) were hospitalized for cerebrovascular events, 1.1% (95%CI:0.8‐1.3%;I²=85%) for ischemic stroke, and 0.2% (95%CI:0.1‐0.3%; I²=64%) for hemorrhagic stroke. Compared to non‐infected contemporary or historical controls, patients with SARS‐CoV‐2 infection had increased odds of ischemic stroke (OR=3.58,95%CI:1.43‐8.92; I²=43%) and cryptogenic stroke (OR=3.98,95%CI:1.62‐9.77;I²=0%). Diabetes mellitus was found to be more prevalent among SARS‐CoV‐2 stroke patients compared to non‐infected contemporary or historical controls (OR=1.39, 95%CI:1.04‐1.86; I²=0%). SARS‐CoV‐2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR=1.42,95%CI:0.65‐3.10; I²=0%) or endovascular thrombectomy (OR=0.78,95%CI:0.35‐1.74; I²=0%) among hospitalized ischemic stroke patients during the COVID‐19 pandemic. Odds for in‐hospital mortality were higher among SARS‐CoV‐2stroke patients compared to non‐infected contemporary or historical stroke patients (OR=5.60,95%CI:3.19‐9.80;I²=45%).

Interpretation

SARS‐CoV‐2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular. It may also be related to an increased mortality risk.

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