Few, but severe strokes in hospitalised COVID-19 patients

Remarkable: patients did not have a greater risk of cardiovascular disease beforehand

Strokes do not often occur in hospitalised COVID-19 patients, but when they occur they are often severe, according to research led by scientists at UMC Utrecht. Of stroke patients 71.1% became severely disabled or died. Pulmonary embolisms occur more often, especially in COVID-19 patients who end up in intensive care. The researchers published this online at medRxiv.org. The Dutch Heart Foundation funded this research.

Few, but severe strokes
Strokes occurred in 1.8% of COVID-19 patients, and slightly more often in people treated in intensive care (2.7%). It was remarkable that these patients did not have an increased risk of cardiovascular disease prior to hospital admission compared to people without a stroke. COVID-19 patients with a stroke have greater risk of dying during hospitalization than those without a stroke. Half of the strokes occurred in relatively young COVID-19 patients who entered intensive care (mean age: 66.5 years). Their strokes were also more severe than those in the nursing ward. Whether this is due to the severity of the infection or other factors is yet unknown. A severe infection is in general unfavourable for recovery after a stroke.

More frequently blood clots in lung vessels
The researchers also looked into complications due to blood clots in lung vessels in COVID-19 patients: pulmonary embolisms. Pulmonary embolisms occurred relatively more frequent (4.3%), especially in the ICU (12.9%). One in five people with a stroke also had a pulmonary embolism. In people without a stroke, this number is one in thirteen. Because several doctors observed pulmonary embolisms in many COVID-19 patients in intensive care, a national guideline on anticoagulation in COVID-19 patients was introduced in the first wave. Meanwhile, all COVID-19 patients in the hospital are given anticoagulation to prevent these complications. Whether less pulmonary embolisms and strokes occur as a result of this guideline remains to be determined. Follow-up research should also reveal why strokes and pulmonary embolisms, sometimes even together, occur in COVID-19 patients. This research can clarify which abnormalities in blood clotting and other disease mechanisms play a role in COVID-19.

The STROCORONA study is the largest Dutch study into the occurrence of stroke in COVID-19 patients. The researchers started this research after reports appeared at the start of the COVID-19 crisis that COVID-19 patients who ended up in hospital had an increased risk of strokes. The scientists examined 2,147 COVID-19 patients from 16 Dutch hospitals to see whether they had strokes. They followed these patients between March and August 2020 from hospital admission to discharge. STROCORONA is a neurological sub-study of the international CAPACITY-COVID registry. Researchers from vascular neurology and cardiology at all these centres worked closely together to systematically map the various cardiovascular complications, including stroke. With this registration they hope to gain more insight into the role of cardiovascular disease in COVID-19 patients. The research results are published on medRxiv.org, a platform where researchers can openly share their results before review by other scientists has taken place.

This initiative is a collaboration of the Dutch Association for Cardiology (NVVC), Working Group Cardiological Centers Netherlands (WCN), Dutch Heart Registration (NHR), Netherlands Heart Institute (NL-HI), patient association Harteraad and the Dutch Heart Foundation. Together they are part of in total nineteen leading organisations representing patients, academia, healthcare professionals, industry and government that have joined forces in the Dutch CardioVascular Alliance. They work together and raise money to accelerate solutions for cardiovascular diseases. The research was coordinated by researchers from UMC Utrecht.