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May 20, 2020

Relation of SARS2-CoV-2 and Stroke Evaluated in Patients in a New York Health Care System

May 20, 2020—NYU Langone Health in New York, New York, announced the publication of a study that showed fewer people than previously reported have had strokes as a result of COVID-19; however, strokes that accompany the pandemic virus, SARS-CoV-2, appear to be more severe. The analysis by Shadi Yaghi, MD, et al was published online ahead of print in Stroke.

In the study, which was led by the NYU Grossman School of Medicine, investigators found that < 1% of hospitalized patients who tested positive for the virus during 1 month also had a stroke. This contrasts with the rates reported recently in small studies in China and Italy, which ranged from 2% to 5%.

However, the NYU investigation also showed that patients with both conditions were younger, had worse symptoms, and were at least seven times more likely to die than stroke victims who were not infected.

In the study, investigators used medical records to identify 32 stroke patients among 3,556 people who were being treated for COVID-19 at NYU Langone hospitals in New York City and Long Island between March 15 and April 19. They compared the characteristics of this group with stroke patients without the virus admitted during the same time frame and with patients from the previous year, before the pandemic began.

The investigators found that stroke patients with COVID-19 disease had more severe symptoms than their counterparts without the virus. In fact, during the study period, 63% died, compared with 9% for those without the virus and 5% of pre-pandemic stroke patients.

As noted in the NYU Langone press release, the results also add to earlier research suggesting that strokes among COVID-19 patients form differently than the majority of strokes. The investigators reported that the condition usually occurs when a blood vessel suddenly gets blocked, preventing blood from reaching the brain, whereas among study patients with COVID-19, at least 56% of the strokes appeared to arise from increased blood clotting throughout the body. This finding may offer a clue to how physicians can better treat stroke occurring in patients who have the virus, advised the investigators.

The study’s senior investigator is Jennifer Frontera, MD, a professor in the Department of Neurology at NYU Langone. Dr. Frontera stated in the announcement, “Our findings provide compelling evidence that widespread blood clotting may be an important factor that is leading to stroke in patients with COVID-19. The results point to anticoagulant, or blood thinner therapy, as a potential means of reducing the unusual severity of strokes in people with the coronavirus.”

Dr. Yaghi, who is Director of Clinical Vascular Neurology Research and Assistant Professor in the Department of Neurology at NYU Langone Health, noted that the study is the largest of its kind among COVID-19 stroke victims and adds valuable insight into the poorly understood complications of COVID-19 disease. Dr. Yaghi commented, “Our study suggests that stroke is an uncommon yet important complication of coronavirus given that these strokes are more severe when compared with strokes occurring in patients who tested negative for the virus.”

In addition to investigating anticoagulant therapy, Drs. Frontera and Yaghi plan to continue the study to confirm if the findings are sustained through the end of the year, stated the NYU Langone announcement.

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