Acute stroke associated with novel coronavirus infection COVID-19

Background. COVID-19 is a widespread, important, and frequently fatal disease, considered a risk factor for the development and progression of other pathologies. One of the most common associated conditions is stroke. Objective: to identify the patterns of occurrence and mechanisms of ischemic stroke (IS) development under novel coronavirus infection COVID-19. Patients/Methods. The prospective study included 80 individuals: 20 COVID-19 patients with subsequent IS development (main group);40 COVID-19 patients without cerebrovascular accident (comparison group);20 healthy volunteers (control group). Concen-trations of fibrinogen, antithrombin III, D-dimer, von Willebrand factor (vWF), C-reactive protein (CRP), matrix metalloproteinase-2 (MMP-2), cytokines (interleukin, IL) — IL-6, IL-8, IL-10, tumor necrosis factor-alpha (tumor necrosis factor-alpha, TNF-α) were accessed in peripheral blood. The study was carried out from November 2020 to February 2021. The primary endpoint of the study was IS development in COVID-19 patients. Results. In 70% patients of the main group a stroke developed by the end of the second week from the infection onset. The main risk factor in 12 (57%) COVID-19 patients with an unfavorable stroke course and subsequent development of multiple organ failure syndrome (MOFS) was a high comorbidity with various forms of circulatory system pathology. All 12 patients with IS and MOFS (100%) showed a statistically significant changes in many clinical and laboratory parameters by the end of the first day after admission to the hospital: they had arterial hypertension (100%), tachycardia (80%), significant increased blood levels of D-dimer (83%), vWF (75%), IL-10 (92%), TNF-α (92%), CRP (100%), MMP-2 (100%). Conclusions. COVID-19 and high comorbidity with various forms of circulatory system pathology are 2 significant risk factors for both the occurrence and adverse course of stroke and its outcomes. Arterial hypertension, increased blood levels of D-dimer, vWF, IL-10, TNF-α, CRP and MMP-2 are the early predictors of acute MOFS development in more than 75% of COVID-19 patients with stroke. © Kabaeva E.N., Litvitskiy P.F., Artyukov O.P., Tushova K.A., Nozdryukhina N.V., Ershov A.V., 2022

COVID-19 and thrombotic microangiopathy

As shown by numerous studies conducted during the pandemic, the severe course of COVID-19 is accompanied by multiple organ failure. Cytokine storm, hypercoagulation, complement hyperactivation and other arms comprise the overall picture of the pathogenesis of the severe disease course. The frequent diagnosis of multiple microvascular thrombosis in lung, heart, and kidneys, as well as the presence of platelet-fibrin thrombi there and signs of terminal organ damage, suggest a possible involvement of thrombotic microangiopathy (TMA) in the development of multiple organ failure. In this regard, it is especially important to timely diagnose TMA and start pathogenetic therapy. These measures can significantly reduce mortality due to the novel disease. Heparins and direct oral anticoagulants are the mainstay for prevention and treatment of venous thromboembolism in patients with COVID-19, but their effectiveness in the presence of TMA is questionable. It has been proven that anticoagulants use in critically ill patients with COVID-19 for prevention of large vessel thrombosis is effective, but their role in the prevention of microthrombosis is not clear. Here we review the currently available information on thrombotic microangiopathy, as well as a review of literature data describing TMA-like conditions in COVID-19, discuss potential pathophysiology of the condition development and proposed therapeutic approaches. © Obstetrics, Gynecology and Reproduction 2021.