A new study from the University of Pennsylvania published in Stroke shows a low risk of stroke in patients hospitalized for COVID-19.
Researchers found that 2.4% of individuals hospitalized for COVID-19 had an ischemic stroke and the majority of these individuals had existing risk factors, such as high blood pressure (95%), a history of diabetes (60%), and traditional stroke mechanisms, such as heart failure. Additionally, over 1/3 had a history of a previous stroke. The authors of this study say the results suggest that these cerebrovascular events in hospitalized individuals with COVID-19 are likely tied to existing conditions, and not the sole consequence of the virus. However, other factors could be at play and require continued research. Although the precise mechanisms linking cerebrovascular events to COVID-19 remain uncertain at this time, it has recently been reported that the viral infection, SARS-CoV-2, causes inflammation and a hypercoagulable state, both could be potential mechanisms leading to stroke.
In addition to the incidents of stroke, the research team found that 0.9% of hospitalized individuals with COVID-19 had intracranial hemorrhage. Although the rate of stroke in hospitalized individuals with COVID-19 is comparable to studies in Wuhan, China and Italy, the rate of intracranial hemorrhage, which has not previously been reported, is higher than investigators expected. The authors note this could be tied to the increasing use of anticoagulant therapy in COVID-19 patients and requires additional exploration.
To evaluate the risk and incidence of stroke in COVID-19 hospitalized individuals, researchers analyzed data from 844 individuals with COVID-19 admitted to the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Pennsylvania Hospital between March and May.
In this study, the majority of individuals with stroke and COVID-19 had existing risk factors, such as high blood pressure and diabetes. There have also been other published reports of higher rates of stroke in individuals with COVID-19. The relationships between COVID-19 and cerebrovascular disease are an area of intense study.
The population of participants for the study was unique as well, with a more diverse cohort compared to previous reported studies. Black participants accounted for 68% of the study population and were 80% of the hospitalized patients who had a stroke. The cohort of participants were mean age 59, and the mean age of individuals with ischemic stroke was 64, with only 1 individual under age 50.
Bettina Balint, MD
David Z. Rose, MD