Please use this identifier to cite or link to this item: https://doi.org/10.1007/s11239-020-02228-y
Title: COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature
Authors: Tan, Ying-Kiat 
Goh, Claire 
Leow, Aloysius ST
Tambyah, Paul A 
Ang, Alicia
Yap, Eng-Soo
Tu, Tian-Ming
Sharma, Vijay K 
Yeo, Leonard LL 
Chan, Bernard PL
Tan, Benjamin YQ
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Hematology
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Antiphospholipid antibodies
COVID-19
Hypercoagulable
Ischemic stroke
Thrombosis
Issue Date: 13-Jul-2020
Publisher: SPRINGER
Citation: Tan, Ying-Kiat, Goh, Claire, Leow, Aloysius ST, Tambyah, Paul A, Ang, Alicia, Yap, Eng-Soo, Tu, Tian-Ming, Sharma, Vijay K, Yeo, Leonard LL, Chan, Bernard PL, Tan, Benjamin YQ (2020-07-13). COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. JOURNAL OF THROMBOSIS AND THROMBOLYSIS 50 (3) : 587-595. ScholarBank@NUS Repository. https://doi.org/10.1007/s11239-020-02228-y
Abstract: Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean d-dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated d-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis.
Source Title: JOURNAL OF THROMBOSIS AND THROMBOLYSIS
URI: https://scholarbank.nus.edu.sg/handle/10635/192361
ISSN: 09295305
1573742X
DOI: 10.1007/s11239-020-02228-y
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