Patients with COVID-19 May Have Lower Stroke Rates Than Previously Suggested

Fewer people than previously reported have a stroke as a result of 2019 coronavirus disease (COVID-19), a new analysis finds. However, strokes that accompany the pandemic virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appear to be more severe.

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

However, the current investigation also revealed that people with both conditions were younger, had worse symptoms, and were at least seven times more likely to die than people who had a stroke and were not infected.

“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,” says study lead author Shadi Yaghi, MD, assistant professor in the Department of Neurology at NYU Langone Health.

Dr. Yaghi, who is also research director of the Center for Stroke and Neurovascular Diseases and director of vascular neurology at NYU Langone Hospital—Brooklyn, cautions that the public should always take stroke symptoms seriously. Should they experience symptoms like trouble walking or speaking or sudden paralysis of the face or limbs, they should seek immediate medical care regardless of concerns about exposure to the virus.

The new study, published May 20 in the journal Stroke, is the largest of its kind, says Dr. Yaghi, among patients with COVID-19 and stroke and adds valuable insight into the poorly understood complications of COVID-19.

For the investigation, the researchers used medical records to identify 32 patients with stroke 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. Then, they compared the characteristics of this group with patients without the virus who had a stroke admitted during the same timeframe, as well as with patients from the previous year, before the pandemic began.

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

The results also add to other early research suggesting that strokes among patients with COVID-19 form differently than the majority of strokes. The condition, the researchers say, usually occurs when a blood vessel suddenly gets blocked, preventing blood from reaching the brain. Among study patients with COVID-19, at least 56 percent of the strokes appeared to arise from increased blood-clotting throughout the body. This finding may offer a clue as to how physicians can better treat stroke occurring in patients who have the virus, the study authors say.

“Our findings provide compelling evidence that widespread blood-clotting may be an important factor that is leading to stroke in patients with COVID-19,” says study senior author Jennifer A. Frontera, MD, professor in NYU Langone’s Department of Neurology. “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.”

In addition to investigating anticoagulant therapy, both Dr. Frontera and Dr. Yaghi plan to continue the study to see whether the findings hold true through the end of the year.

Funding for the study was provided by National Institutes of Health grant K08 NS091499.

In addition to Dr. Yaghi and Dr. Frontera, other NYU Langone researchers are Koto Ishida, MD; Jose L. Torres, MD; Eytan Raz, MD, PhD; Kelley A. Humbert, MD; Tushar Trivedi, MD; Kaitlyn Lillemoe, MD; Shazia A. Alam, DO; Matthew D. Sanger, MD; Sun Kim, MD; Erica Scher, RN, MPH; Seena Dehkharghani, MD; Michael Wachs, MHA; Omar Tanweer, MD; Frank M. Volpicelli, MD; Brian P. Bosworth, MD; and Aaron S. Lord, MD. Other researchers involved in the study are Brian Mac Grory, MD, at Brown University in Providence, Rhode Island; and Nils Henninger, PhD, MD, at the University of Massachusetts in Worcester.