Abstract
Coronavirus disease 2019 (COVID-19) is the most overwhelming medical threat of the past few decades. The infection, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can cause serious illness leading to respiratory insufficiency, and, in severely ill patients, it can progress to multiple organ failure leading to death. It has been noted from the earliest reports that the disease influences the hemostasis system and a hallmark of severe infection is elevated D-dimer levels. The profound coagulation changes in COVID-19 seem to be linked to inflammation-related events and severe endothelial cell injury. Besides the high incidence of venous thromboembolic events in SARS-CoV-2 infections, arterial events, including cerebrovascular events, were found to be associated with the disease. In this review, we aimed to summarize the available literature on COVID-19-associated coagulopathy and thrombosis. Furthermore, we performed a systematic search of the literature to identify the characteristics of stroke in COVID-19. Our findings showed that acute ischemic stroke (AIS) is the most frequent type of stroke occurring in infected patients. In most cases, stroke was severe (median NIHSS:16) and most of the patients had one or more vascular risk factors. Laboratory findings in AIS patients were consistent with COVID-19-associated coagulopathy, and elevated D-dimer levels were the most common finding. The outcome was unfavorable in most cases, as a large proportion of the reported patients died or remained bedridden. Limited data are available as yet on outcomes after acute vascular interventions in COVID-19 patients. In the future, well-designed studies are needed to better understand the risk of stroke in COVID-19, to optimize treatment, and to improve stroke care.
Highlights
Coronavirus disease 2019 (COVID-19) is the most overwhelming medical threat of the past few decades, with more than seven million infections and 400,000 deaths worldwide up to the beginning of June 2020
Beyond presenting COVID-19-associated coagulopathy and venous thrombotic events, we focus on COVID-19-associated cerebrovascular diseases, with an effort to provide a comprehensive assessment of published cases by a systematic search of the literature
Disagreements were resolved by consensus and involving a third author (Z.B.).The following data were extracted: age, sex, type and territory of the stroke, severity of the stroke based on the National Institutes of Health Stroke Scale (NIHSS), previous diseases, treatment, outcome, and relevant laboratory findings on admission
Summary
Coronavirus disease 2019 (COVID-19) is the most overwhelming medical threat of the past few decades, with more than seven million infections and 400,000 deaths worldwide up to the beginning of June 2020. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the family Coronaviridae. These viruses possess a positive-sense, single-strand RNA genome [3]. SARS-CoV-1 and Middle East respiratory syndrome coronavirus (MERS-CoV) caused lethal illnesses in some cases and were responsible for two epidemics in the past twenty years [5,6]. A well-known characteristic of coronaviruses is that they can spread via animals (mammals and birds) Their zoonotic origin, combined with their frequent genomic recombination, genetic diversity, and high human–animal interaction, led to the outbreak of the current pandemic at the seafood market in Wuhan [1]. Beyond presenting COVID-19-associated coagulopathy and venous thrombotic events, we focus on COVID-19-associated cerebrovascular diseases, with an effort to provide a comprehensive assessment of published cases by a systematic search of the literature
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