Consequences and risk factors of ischemic stroke and COVID-19

Abstract

Background: Many factors, such as endothelial cell damage, thrombin generation and platelet activation, and cytokine storms, cause blood coagulation disorders during the coronavirus infection, resulting in many cerebral ischemia strokes. In the case of severe “COVID-19” infection, the risk of stroke has increased five times. In meta-analysis studies, among 108,571 patients with “COVID-19” infection, 7.4% (1329) had IS, and 11.6% (180) had a hemorrhage stroke. Aim: This study aims to determine risk factors, clinical features, D-dimer, and stroke severity in patients with ischemic stroke infected with “COVID-19”. Materials and Methods: We conducted the study based on Shastin’s Third Central Hospital of Mongolia from December 01, 2020, to December 31, 2021, comparing COVID-19 (n=29) and without COVID-19 (n=80). One hundred nine cases of ischemic stroke were studied for demographics, clinical features, and D-dimer. The study’s results were analyzed using the STATA-14 program Results: 65.14% (71) of patients with ischemic stroke included were men, and 34.8% (38) were women. There was no difference in vascular risk factors between the two groups with and without infection with COVID-19. Out of all the patients, 45.8% (50) had mild symptoms, 41.2% (45) had moderate symptoms, and 12.8% (14) had severe symptoms. According to the TOAST classification, LVO was the most common (51.7% 15/109). Nine (31%) patients had cardioembolic, and 17.2% (5) small vessel disease. The higher the severity of stroke (measured by NIHSS), the higher the D-dimer levels. The AIS group with COVID-19 had significantly higher levels of high-density lipoprotein (HDL) at 1.04±0.03 (p-0.05), total cholesterol at 7.25±0.37 (p-0.03), and D-dimer at 5.48±0.21 (p-0.000). Conclusion: COVID-19 with ischemic stroke with comorbidities including arterial hypertension, diabetes mellitus, and coronary heart disease increases D-dimer levels, leading to coagulopathy that infarction volume, complications, and prognosis are adversely affected.