Ischemic Stroke in Patients with SARS-CoV-2 Infection and Coagulation Disorders

Based on literature search in the medical databases PubMed, LiLacs, WoS and IBECS and using the combination of descriptors “cerebral infarction” OR “stroke” OR “brain ischemia” OR “thrombosis” AND “coronavirus; “SARS-Cov-2”, “Covid-19”, we analyzed all case reports on COVID-19 and ischemic stroke, regardless of publication time.

Results

In 12 articles analyzed in this review, a total of 52 patients (67.3% men and 32.7% women) with Covid-19 had ischemic stroke. The average age was 57.4±14.4 years, ranging from 31 to 87 years. Neurological symptoms appeared 10.7±8.1 days after the diagnosis of Covid-19. The main laboratory changes were C-reactive protein (80.8%), D-dimer (78.9%), and ferritin (13.5%). The therapeutic measures used were anticoagulation (65.4%), anti-platelet aggregation (19.2%), thrombectomy (15.4%), thrombolysis (9.6%), and antithrombotics (7.7%). Risk factors for ischemic stroke were present in 76.9% of patients and in most of them there were two or more factors, more often: arterial hypertension (76.9%), diabetes mellitus (36.5%), hyperlipidemia (32.7%), and cardiopathy (30.8%). There was a higher mortality in patients with risk factors (85%).

Conclusions

Hypercoagulopathy and endothelial lesions caused by COVID-19, associated with the neuroinvasive potential of the SARS-Cov-2 virus may cause ischemic strokes.