Hospitalized COVID-19 Patients at Higher Risk for Ischemic Stroke

New research presented at the American Stroke Association's International Stroke Conference 2021 found that patients hospitalized with COVID-19 had a higher risk of stroke compared with patients who had similar infectious conditions such as influenza and sepsis. Those who had an ischemic stroke were more likely to be older, male, Black race, or have high blood pressure, Type 2 diabetes or an irregular heartbeat (atrial fibrillation) compared with other COVID-19 patients 

Researchers accessed the American Heart Association's COVID-19 Cardiovascular Disease Registry to investigate stroke risk among patients hospitalized for COVID-19, their demographic characteristics, medical histories and in-hospital survival. The COVID-19 Registry data pulled for this study included more than 20,000 patients hospitalized with COVID-19 across the U.S. between January and November 2020.

Two hundred eighty-one people (1.4%) in the COVID-19 CVD Registry had a stroke confirmed by diagnostic imaging during hospitalization. Of these, 148 patients (52.7%) experienced ischemic stroke; 7 patients (2.5%) had transient ischemic attack (TIA); and 127 patients (45.2%) experienced a bleeding stroke or unspecified type of stroke.

"These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown," said lead study author Saate S. Shakil, MD, a cardiology fellow at the University of Washington in Seattle. "As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems."

The study also reported that COVID-19 patients with any type of stroke were more likely to be male (64%) and older (average age 65), and spent 22 days in the hospital, compared to 10 days of hospitalization for patients without stroke. Ischemic stroke  44% had

In-hospital deaths were more than twice as high among stroke patients (37%) compared to patients without stroke (16%). The study also found that 44% of patients who had an ischemic stroke also had Type 2 diabetes, most of the ischemic stroke patients had high blood pressure (80%) and 18% of ischemic stroke patients had atrial fibrillation.

In addition, stroke risk varied by race. Black patients accounted for 27% of the patients in the COVID-19 CVD Registry pool for this analysis; however, 31% of ischemic stroke cases were among Black patients.

"We know the COVID-19 pandemic has disproportionately affected communities of color, but our research suggests Black Americans may have higher risk of ischemic stroke after contracting the virus, as well," Shakil said. "Stroke on its own can have devastating consequences and recovering from COVID-19 is often a difficult path for those who survive. Together, they can exact a significant toll on patients who have had both conditions."