US Pharm. 2021;46(1):3.

Patients who suffer a stroke while infected with COVID-19 face greater disability in the aftermath, according a recent study led by University College London (UCL) researchers. Having COVID-19 at stroke onset was also associated with more than double the mortality rate of other stroke patients, according to the findings published in the Journal of Neurology, Neurosurgery & Psychiatry.

The UCL scientists uncovered evidence that those of Asian descent may be more prone to COVID-19–associated ischemic strokes than those in other groups in the United Kingdom. Lead researcher Dr. Richard Perry of UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery said, “By comparing characteristics and outcomes of strokes experienced by people with and without COVID-19, we found that there were differences between the groups, suggesting that COVID-19 exerts an influence over the presentation of stroke. Some of the differences relate to what other studies are uncovering about COVID-19, in that it might make blood stickier and more likely to clot.”

The research results supplement earlier studies by UCL scientists that have also suggested some individuals with COVID-19 are experiencing neurologic symptoms and that the infection may enhance the risk of stroke.

The investigators examined evidence from 86 people who had suffered a stroke in England or Scotland earlier this year and had COVID-19 at stroke onset, comparing them with 1,384 stroke cases in people without evidence of COVID-19 infection. The researchers found that ischemic stroke patients who also had COVID-19 were only half as likely to leave the hospital without any disability as those without COVID-19.

Ischemic strokes in COVID-19 patients were around twice as likely to be caused by the blockage of more than one large blood vessel in the brain (18% vs. 8%), which the researchers say suggests evidence of abnormal blood clotting. They also found that the COVID-19–associated strokes were more severe, with an average stroke severity (NIH Stroke Scale) score of 8, compared with 5 in the control group.

Levels of D-dimers, a protein marker for the stickiness of blood, were also higher in COVID-19–related ischemic stroke than in other ischemic strokes. The findings match up with other studies showing that people with COVID-19 appear to have sticky blood that is more liable to clot.

In addition, the researchers found differences by ethnicity, as people of Asian descent were overrepresented (by more than twofold) in the COVID-19 group compared with White or Black patients.

For a detailed examination of stroke and other neurologic-related impacts of coronavirus infection, see the continuing education article in this issue (page 33) titled “Understanding the Neurologic Manifestations of COVID-19” by Elsen C. Jacob, PharmD, BCPS, BCGP, CPPS.