COVID-19-related strokes are associated with increased mortality and morbidity: A multicenter comparative study from Bengaluru, South India

So as soon as you are diagnosed with COVID-19 get the appropriate treatments to prevent it from escalating to a stroke. Don't tough it out at home. 

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:

COVID-19-related strokes are associated with increased mortality and morbidity: A multicenter comparative study from Bengaluru, South India

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Thomas Mathew, Saji K John, GRK Sarma, ...

First Published December 6, 2020 Research Article Find in PubMed 

https://doi.org/10.1177/1747493020968236

Article information

   

Abstract

Background

COVID-19-related strokes are increasingly being diagnosed across the world. Knowledge about the clinical profile, imaging findings, and outcomes is still evolving. Here we describe the characteristics of a cohort of 62 COVID-19-related stroke patients from 13 hospitals, from Bangalore city, south India.

Objective

To describe the clinical profile, neuroimaging findings, interventions, and outcomes in COVID-19-related stroke patients.

Methods

This is a multicenter retrospective study of all COVID-19-related stroke patients from 13 hospitals from south India; 1st June 2020–31st August 2020. The demographic, clinical, laboratory, and neuroimaging data were collected along with treatment administered and outcomes. SARS–CoV-2 infection was confirmed in all cases by RT-PCR testing. The data obtained from the case records were entered in SPSS 25 for statistical analysis.

Results

During the three-month period, we had 62 COVID-19-related stroke patients, across 13 centers; 60 (97%) had ischemic strokes, while 2 (3%) had hemorrhagic strokes. The mean age of patients was 55.66 ± 13.20 years, with 34 (77.4%) males. Twenty-six percent (16/62) of patients did not have any conventional risk factors for stroke. Diabetes mellitus was seen in 54.8%, hypertension was present in 61.3%, coronary artery disease in 8%, and atrial fibrillation in 4.8%. Baseline National Institutes of Health Stroke Scale score was 12.7 ± 6.44. Stroke severity was moderate (National Institutes of Health Stroke Scale 5–15) in 27 (61.3%) patients, moderate to severe (National Institutes of Health Stroke Scale 16–20) in 13 (20.9%) patients and severe (National Institutes of Health Stroke Scale 21–42) in 11 (17.7%) patients. According to TOAST classification, 48.3% was stroke of undetermined etiology, 36.6% had large artery atherosclerosis, 10% had small vessel occlusion, and 5% had cardioembolic strokes. Three (5%) received intravenous thrombolysis with tenecteplase 0.2 mg/kg and 3 (5%) underwent mechanical thrombectomy, two endovascular and one surgical. Duration of hospital stay was 16.16 ± 6.39 days; 21% (13/62) died in hospital, while 37 (59.7%) had a modified Rankin score of 3–5 at discharge. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality. A comparison to 111 historical controls during the non-COVID period showed a higher proportion of strokes of undetermined etiology, higher mortality, and higher morbidity in COVID-19-related stroke patients.

Conclusion

COVID-19-related strokes are increasingly being recognized in developing countries, like India. Stroke of undetermined etiology appears to be the most common TOAST subtype of COVID-19-related strokes. COVID-19-related strokes were more severe in nature and resulted in higher mortality and morbidity. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality.

Keywords COVID-19, SARS–CoV2, ischemic stroke, thrombolysis, mortality, morbidity, India

Introduction

Recent evidence surfacing across the globe suggests that SARS–CoV-2 infection is associated with both ischemic and hemorrhagic strokes. Stroke appears to be one of the dangerous neurological complications of SARS–CoV-2 infection. Of late, with surges in COVID-19 cases in India, especially in the state of Karnataka, we are witnessing an increasing number of COVID-19-related strokes. The knowledge about the clinical profile, imaging findings, and outcomes of COVID-19-related strokes is still evolving. Here we have described the characteristics of COVID-19-related strokes from 13 stroke centers from Bengaluru, an urban city in the state of Karnataka, south India. We have compared these observations with a cohort of non-COVID strokes, during the same months of the previous year and analyzed the factors associated with mortality in COVID-19-related stroke patients.