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Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study.
Stroke Vasc Neurol. 2020 Jul 02 [Online ahead of print]SV

Abstract

BACKGROUND AND PURPOSE

COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Apart from respiratory complications, acute cerebrovascular disease (CVD) has been observed in some patients with COVID-19. Therefore, we described the clinical characteristics, laboratory features, treatment and outcomes of CVD complicating SARS-CoV-2 infection.

MATERIALS AND METHODS

Demographic and clinical characteristics, laboratory findings, treatments and clinical outcomes were collected and analysed. Clinical characteristics and laboratory findings of patients with COVID-19 with or without new-onset CVD were compared.

RESULTS

Of 219 patients with COVID-19, 10 (4.6%) developed acute ischaemic stroke and 1 (0.5%) had intracerebral haemorrhage. COVID-19 with new onset of CVD were significantly older (75.7±10.8 years vs 52.1±15.3 years, p<0.001), more likely to present with severe COVID-19 (81.8% vs 39.9%, p<0.01) and were more likely to have cardiovascular risk factors, including hypertension, diabetes and medical history of CVD (all p<0.05). In addition, they were more likely to have increased inflammatory response and hypercoagulable state as reflected in C reactive protein (51.1 (1.3-127.9) vs 12.1 (0.1-212.0) mg/L, p<0.05) and D-dimer (6.9 (0.3-20.0) vs 0.5 (0.1-20.0) mg/L, p<0.001). Of 10 patients with ischemic stroke; 6 received antiplatelet treatment with aspirin or clopidogrel; and 3 of them died. The other four patients received anticoagulant treatment with enoxaparin and 2 of them died. As of 24 March 2020, six patients with CVD died (54.5%).

CONCLUSION

Acute CVD is not uncommon in COVID-19. Our findings suggest that older patients with risk factors are more likely to develop CVD. The development of CVD is an important negative prognostic factor which requires further study to identify optimal management strategy to combat the COVID-19 outbreak.

Authors+Show Affiliations

Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA.Neurovascular Division, Department of Neurology, Barrow Neurological Institute/Saint Joseph Hospital Medical Center, Phoenix, Arizona, USA.Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China hubo@mail.hust.edu.cn jinhuijuan1983@163.com.Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China hubo@mail.hust.edu.cn jinhuijuan1983@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32616524

Citation

Li, Yanan, et al. "Acute Cerebrovascular Disease Following COVID-19: a Single Center, Retrospective, Observational Study." Stroke and Vascular Neurology, 2020.
Li Y, Li M, Wang M, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020.
Li, Y., Li, M., Wang, M., Zhou, Y., Chang, J., Xian, Y., Wang, D., Mao, L., Jin, H., & Hu, B. (2020). Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke and Vascular Neurology. https://doi.org/10.1136/svn-2020-000431
Li Y, et al. Acute Cerebrovascular Disease Following COVID-19: a Single Center, Retrospective, Observational Study. Stroke Vasc Neurol. 2020 Jul 2; PubMed PMID: 32616524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. AU - Li,Yanan, AU - Li,Man, AU - Wang,Mengdie, AU - Zhou,Yifan, AU - Chang,Jiang, AU - Xian,Ying, AU - Wang,David, AU - Mao,Ling, AU - Jin,Huijuan, AU - Hu,Bo, Y1 - 2020/07/02/ PY - 2020/05/19/received PY - 2020/06/05/revised PY - 2020/06/12/accepted PY - 2020/7/4/pubmed PY - 2020/7/4/medline PY - 2020/7/4/entrez KW - Anticoagulation therapy KW - COVID-19 KW - Cerebrovascular disease KW - Thromboembolic events KW - stroke JF - Stroke and vascular neurology JO - Stroke Vasc Neurol N2 - BACKGROUND AND PURPOSE: COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Apart from respiratory complications, acute cerebrovascular disease (CVD) has been observed in some patients with COVID-19. Therefore, we described the clinical characteristics, laboratory features, treatment and outcomes of CVD complicating SARS-CoV-2 infection. MATERIALS AND METHODS: Demographic and clinical characteristics, laboratory findings, treatments and clinical outcomes were collected and analysed. Clinical characteristics and laboratory findings of patients with COVID-19 with or without new-onset CVD were compared. RESULTS: Of 219 patients with COVID-19, 10 (4.6%) developed acute ischaemic stroke and 1 (0.5%) had intracerebral haemorrhage. COVID-19 with new onset of CVD were significantly older (75.7±10.8 years vs 52.1±15.3 years, p<0.001), more likely to present with severe COVID-19 (81.8% vs 39.9%, p<0.01) and were more likely to have cardiovascular risk factors, including hypertension, diabetes and medical history of CVD (all p<0.05). In addition, they were more likely to have increased inflammatory response and hypercoagulable state as reflected in C reactive protein (51.1 (1.3-127.9) vs 12.1 (0.1-212.0) mg/L, p<0.05) and D-dimer (6.9 (0.3-20.0) vs 0.5 (0.1-20.0) mg/L, p<0.001). Of 10 patients with ischemic stroke; 6 received antiplatelet treatment with aspirin or clopidogrel; and 3 of them died. The other four patients received anticoagulant treatment with enoxaparin and 2 of them died. As of 24 March 2020, six patients with CVD died (54.5%). CONCLUSION: Acute CVD is not uncommon in COVID-19. Our findings suggest that older patients with risk factors are more likely to develop CVD. The development of CVD is an important negative prognostic factor which requires further study to identify optimal management strategy to combat the COVID-19 outbreak. SN - 2059-8696 UR - https://www.unboundmedicine.com/medline/citation/32616524/Acute_cerebrovascular_disease_following_COVID-19:_a_single_center,_retrospective,_observational_study L2 - https://svn.bmj.com/cgi/pmidlookup?view=long&amp;pmid=32616524 DB - PRIME DP - Unbound Medicine ER -
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