:: Volume 10, Issue 1 (Winter 2021) ::
Shefaye Khatam 2021, 10(1): 85-98 Back to browse issues page
Association between COVID-19 Infection and Thrombotic Stroke: A Systematic Review
Firoozeh Alavian *
Department of Basic Sciences, Farhangian University, Tehran, Iran , alavian.firoozeh@gmail.com
Abstract:   (3711 Views)
Introduction: Coronavirus disease (COVID-2019) is a global epidemic and emergency that has caused significant changes in health care systems. The previous studies have reported an increased risk of thromboembolic events, including stroke, in patients with COVID-19. This systematic review was performed to describe the frequency, clinical features, and cognitive function of patients with thrombotic stroke and COVID-19 infection. Materials and Methods: The articles were searched based on the search strategy considered in the main databases of Google Scholar, PubMed, and Science Direct for the relevant manuscripts in the period from November 2019 to July 2021. The selected articles were considered based on criteria such as patient's age, time of onset of stroke, previous disease history, symptoms, inflammatory markers, drugs used, and final fate of patients. Results: Out of 1672 articles obtained from the initial search, 26 articles had inclusion criteria and were therefore included in the final analysis. The results of the study showed that the frequency of stroke and mortality in older people with COVID-19 infection is higher than in other ages. However, when systemic symptoms are severe, young people are prone to neurological complications. The Previous history of underlying diseases increased the severity and frequency of the disease. The onset of stroke varied from 2 hours to 4 weeks after the first symptoms of COVID-19. Furthermore, the symptoms of the disease appear in patients in more or less various forms, which are somewhat improved by the use of SARS- COV-2 suppressive drugs, prophylactic and anti-clotting drugs. Finally, the increased risk of ischemic stroke is probably multifactorial and is reflected by activation of coagulation and inflammatory pathways, increased levels of D- dimer, C- reactive protein, thrombin, fibrin, red blood cell deposition, lactate dehydrogenase, and lymphopenia. Conclusion: Although most patients with COVID-19 have a predominantly respiratory infection, some patients develop venous and arterial thromboembolic complications that can lead to stroke. However, further studies are needed to provide stronger estimates of the increased risk of stroke due to COVID-19 infection and to elucidate the exact pathophysiology of the SARS- COV-2 association with the risk of thrombotic stroke.
Keywords: COVID-19, SARS-CoV-2, Stroke, Thrombosis
Full-Text [PDF 1444 kb]   (944 Downloads)    
Type of Study: Systematic Review --- Open Access, CC-BY-NC | Subject: Basic research in Neuroscience
References
1. Li X, Zai J, Zhao Q, Nie Q, Li Y, Foley BT, et al. Evolutionary history, potential intermediate animal host, and cross‐ species analyses of SARS‐ CoV‐2. Journal of medical virology. 2020; 92(6): 602-11. [DOI:10.1002/jmv.25731]
2. Amiri AS, Akram M, BEMS M. COVID- 19: The challenges of the human life. Social Work & Social Sciences Rewiew. 2020; 17(1).
3. Alavian F. SARS‐ CoV- 2 Neuroinvasion Potential; Narrative Review. Journal of Military Medicine. 2020; 22(11): 1153-61. eng.
4. Alavian F, Alavian K. Pregnancy and COVID- 19: Physiology, some Challenges, and Solutions. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2021; 24(1): 99-111.
5. Wijeratne T, Sales C, Karimi L, Crewther SG. Acute ischemic stroke in COVID- 19: a case- based systematic review. Frontiers in Neurology. 2020; 11. [DOI:10.3389/fneur.2020.01031]
6. Alavian F, Hajizadeh S, Bigdeli MR, Javan M. The role of protein kinase C in ischemic tolerance induced by hyperoxia in rats with stroke. EXCLI journal. 2012; 11: 188.
7. Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019; 11(9): 2542. [DOI:10.18632/aging.101931]
8. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large- vessel stroke as a presenting feature of Covid- 19 in the young. New England Journal of Medicine. 2020; 382(20): e60. [DOI:10.1056/NEJMc2009787]
9. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Bmj. 2020; 368. [DOI:10.1136/bmj.m1091]
10. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Jama. 2020; 323(11): 1061- 9. [DOI:10.1001/jama.2020.1585]
11. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID- 19 in Wuhan, China: a retrospective cohort study. The lancet. 2020; 395(10229): 1054-62. [DOI:10.1016/S0140-6736(20)30566-3]
12. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID- 19 patients admitted to an academic hospital in Milan, Italy. Thrombosis research. 2020; 191: 9-14. [DOI:10.1016/j.thromres.2020.04.024]
13. Poillon G, Obadia M, Perrin M, Savatovsky J, Lecler A. Cerebral venous thrombosis associated with COVID- 19 infection: causality or coincidence? Journal of neuroradiology. 2021; 48(2): 121. [DOI:10.1016/j.neurad.2020.05.003]
14. Prasad A, Kataria S, Srivastava S, Lakhani DA, Sriwastava S. Multiple embolic stroke on magnetic resonance imaging of the brain in a COVID- 19 case with persistent encephalopathy. Clinical Imaging. 2021; 69: 285-8. [DOI:10.1016/j.clinimag.2020.09.010]
15. Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID- 19 disease severity and fatality: A systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020; 14(5): 1133-42. [DOI:10.1016/j.dsx.2020.07.005]
16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009; 62(10): e1-e34. [DOI:10.1016/j.jclinepi.2009.06.006]
17. Mohamed IZB, Balson L, Madathil S. Massive bilateral stroke in a COVID- 19 patient. BMJ Case Reports CP. 2020; 13(8): e236-54. [DOI:10.1136/bcr-2020-236254]
18. Fara MG, Stein LK, Skliut M, Morgello S, Fifi JT, Dhamoon MS. Macrothrombosis and stroke in patients with mild Covid‐19 infection. Journal of Thrombosis and Haemostasis. 2020; 18(8): 2031-3. [DOI:10.1111/jth.14938]
19. Bigliardi G, Ciolli L, Giovannini G, Vandelli L, Dell'Acqua ML, Borzì GM, et al. Middle cerebral artery ischemic stroke and COVID-19: a case report. Journal of NeuroVirology. 2020; 26(6): 967-9. [DOI:10.1007/s13365-020-00898-1]
20. Viguier A, Delamarre L, Duplantier J, Olivot J-M, Bonneville F. Acute ischemic stroke complicating common carotid artery thrombosis during a severe COVID- 19 infection. Journal of neuroradiology. 2020; 47(5): 393. [DOI:10.1016/j.neurad.2020.04.003]
21. Klein DE, Libman R, Kirsch C, Arora R. Cerebral venous thrombosis: a typical presentation of COVID- 19 in the young. Journal of Stroke and Cerebrovascular Diseases. 2020; 29(8): 104989. [DOI:10.1016/j.jstrokecerebrovasdis.2020.104989]
22. Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, et al. SARS-CoV-2 and stroke in a New York healthcare system. Stroke. 2020; 51(7): 2002-11. [DOI:10.1161/STROKEAHA.120.030335]
23. Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY, et al. Characteristics of ischaemic stroke associated with COVID-19. Journal of Neurology, Neurosurgery & Psychiatry. 2020; 91(8): 889-91. [DOI:10.1136/jnnp-2020-323586]
24. Mowla A, Sizdahkhani S, Sharifian-Dorche M, Selvan P, Emanuel BA, Tenser MS, et al. Unusual pattern of arterial macrothrombosis causing stroke in a young adult recovered from COVID- 19. Journal of Stroke and Cerebrovascular Diseases. 2020; 29(12): 105353. [DOI:10.1016/j.jstrokecerebrovasdis.2020.105353]
25. Nannoni S, de Groot R, Bell S, Markus HS. Stroke in COVID- 19: a systematic review and meta- analysis. International Journal of Stroke. 2021; 16(2): 137-49. [DOI:10.1177/1747493020972922]
26. Al- Mufti F, Amuluru K, Sahni R, Bekelis K, Karimi R, Ogulnick J, et al. Cerebral venous thrombosis in COVID-19: a New York metropolitan cohort study. American Journal of Neuroradiology. 2021. [DOI:10.3174/ajnr.A7134]
27. Siegler JE, Cardona P, Arenillas JF, Talavera B, Guillen AN, Chavarría- Miranda A, et al. Cerebrovascular events and outcomes in hospitalized patients with COVID-19: the SVIN COVID-19 multinational registry. International Journal of Stroke. 2021; 16(4): 437-47. [DOI:10.1177/1747493020959216]
28. AlSheef M, Zaidi ARZ, Abonab M, Obaid M, and Bawazir K, and Zaidi SZA, et al. Dual catastrophe of COVID-19: Massive pulmonary embolism and stroke in a previously healthy young patient: A case report. Journal of Infection and Public Health. 2021; 14(5): 647-50. [DOI:10.1016/j.jiph.2021.01.009]
29. Fuentes B, Alonso de Leciñana M, García- Madrona S, Díaz-Otero F, Aguirre C, Calleja P, et al. Stroke acute management and outcomes during the COVID- 19 outbreak: a cohort study from the Madrid stroke network. Stroke. 2021; 52(2): 552-62.
30. Qureshi AI, Baskett WI, Huang W, Shyu D, Myers D, Raju M, et al. Acute ischemic stroke and covid-19: An analysis of 27 676 patients. Stroke. 2021; 52(3): 905-12. [DOI:10.1161/STROKEAHA.120.031786]
31. Hamouda D, Jillella DV, Bhatt N, Koneru S, Frankel MR, Nogueira RG. Intraluminal carotid thrombosis and acute ischemic stroke associated with COVID- 19. Journal of Neurology. 2021: 1-5. [DOI:10.1161/str.52.suppl_1.P107]
32. Appavu B, Deng D, Dowling MM, Garg S, Mangum T, Boerwinkle V, et al. Arteritis and large vessel occlusive strokes in children after COVID- 19 infection. Pediatrics. 2021; 147(3). [DOI:10.1542/peds.2020-023440]
33. Karvigh SA, Vahabizad F, Banihashemi G, Sahraian MA, Gheini MR, Eslami M, et al. Ischemic stroke in patients with COVID-19 disease: A report of 10 cases from Iran. Cerebrovascular Diseases. 2021; 50(2): 239-44. [DOI:10.1159/000513279]
34. Mullaguri N, Hepburn M, Gebel Jr JM, Itrat A, George P, Newey CR. COVID-19 disease and hypercoagulability leading to acute ischemic stroke. The Neurohospitalist. 2021; 11(2): 131-6. [DOI:10.1177/1941874420960324]
35. Lam K, Lee JH, Cheng P, Ajani Z, Salem MM, Sangha N. Pediatric stroke associated with a sedentary lifestyle during the SARS-CoV-2 (COVID-19) pandemic: a case report on a 17- year- old. Neurological Sciences. 2021; 42(1): 21-3. [DOI:10.1007/s10072-020-04857-w]
36. Alzahrani AA, Al Abdulsalam H, Al-Sakkaf H, Yousef A, Albadr FB. Arterial Thrombosis in an Asymptomatic COVID- 19 Complicated by Malignant Middle Cerebral Artery Syndrome: A Case Report and Literature Review. International Medical Case Reports Journal. 2021; 14: 401. [DOI:10.2147/IMCRJ.S306830]
37. Chakir M, El Jamili M, Boudhar Z, El Hattaoui M. Simultaneous acute myocardial infarction, bilateral pulmonary embolism, and acute ischaemic cerebral stroke, a delayed complication in a patient with COVID-19 infection: case report. European Heart Journal- Case Reports. 2021; 5(6): ytab218. [DOI:10.1093/ehjcr/ytab218]
38. Iqbal P, Laswi B, Jamshaid MB, Shahzad A, Chaudhry HS, Khan D, et al. The Role of Anticoagulation in Post-COVID-19 Concomitant Stroke, Myocardial Infarction, and Left Ventricular Thrombus: A Case Report. The American Journal of Case Reports. 2021; 22: e928852-1. [DOI:10.12659/AJCR.928852]
39. Shah H, Iyer A, Zaghlol R, Raparla S. Case report: Multiple strokes and digital ischemia in a young covid-19 patient. The American Journal of Tropical Medicine and Hygiene. 2021; 104(1): 60. [DOI:10.4269/ajtmh.20-1101]
40. Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World neurosurgery. 2011; 76(6): S85- S90. [DOI:10.1016/j.wneu.2011.07.023]
41. Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, et al. SARS-CoV-2 and stroke characteristics: a report from the multinational COVID-19 Stroke Study Group. Stroke. 2021; 52(5): e117-e30. [DOI:10.1161/str.52.suppl_1.P81]
42. Forster R, Myklebust T, Gravningen K, Kvale R. Increased risk of COVID-19-associated death in people under 70 with cardiovascular disease compared to the general population- A nationwide, registry-based study from Norway. European Heart Journal. 2021; 42(Supplement_1): ehab724. 3135. [DOI:10.1093/eurheartj/ehab724.3135]
43. Lou M, Yuan D, Liao S, Tong L, Li J. Potential mechanisms of cerebrovascular diseases in COVID-19 patients. Journal of NeuroVirology. 2021:1- 17. [DOI:10.1007/s13365-021-00948-2]
44. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Science China Life Sciences. 2020; 63(3): 364-74. [DOI:10.1007/s11427-020-1643-8]
45. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA neurology. 2020; 77(6): 683- 90. [DOI:10.1001/jamaneurol.2020.1127]
46. Manne BK, Denorme F, Middleton EA, Portier I, Rowley JW, Stubben C, et al. Platelet gene expression and function in patients with COVID- 19. Blood. 2020; 136(11): 1317-29. [DOI:10.1182/blood.2020007214]
47. Klok F, Kruip M, Van der Meer N, Arbous M, Gommers D, Kant K, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis research. 2020; 191: 145-7. [DOI:10.1016/j.thromres.2020.04.013]
48. Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke and vascular neurology. 2020; 5(3). [DOI:10.1136/svn-2020-000431]
49. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of thrombosis and haemostasis. 2020; 18(4): 844-7. [DOI:10.1111/jth.14768]
50. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID- 19. The Lancet Haematology. 2020; 7(6): e438-e40. [DOI:10.1016/S2352-3026(20)30145-9]
51. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine. 2020; 180(7): 934-43. [DOI:10.1001/jamainternmed.2020.0994]

XML   Persian Abstract   Print

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Volume 10, Issue 1 (Winter 2021) Back to browse issues page