COVID-19: hemorrhagic stroke rate is low

  • Kvernland A & al.
  • Neurocrit Care
  • 24/08/2020

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Hemorrhagic stroke rates were low overall among patients in New York City hospitalized with COVID-19.
  • Patients who did have stroke tended to be taking anticoagulants.

Why this matters

  • The authors say that their findings suggest that neurological evaluation is imperative and that patients would benefit from several tactics, including:
    • Attempts to wean from sedation for neurologic exams, especially if on anticoagulants.
    • CT screening before initiating anticoagulation.

Key results

  • 34 of 4071 patients who were hospitalized with COVID-19 had hemorrhagic stroke.
  • 78.9% were men.
  • The authors excluded 15 of the 34 patients who had hemorrhagic stroke from the analysis because these cases involved transformation of ischemic stroke.
  • Only 2 of 19 patients were not on an anticoagulant before the stroke.
  • The indication for anticoagulation was suspected COVID-19 hypercoagulability in 11 of 17.
  • Most patients were started on hydroxychloroquine; about a quarter were started on IL-6.
  • 84.2% with hemorrhagic stroke were on mechanical ventilation.
  • The group with stroke had a mortality rate of 84.6%, compared with 5.0% of historic controls (P≤.001).

Study design

  • Retrospective cohort study of patients hospitalized March 1-May 15, 2020.
  • Funding: None specific to this work cited.

Limitations

  • Some strokes may have been missed.
  • Use of hydroxychloroquine was revoked after the study period.