ABSTRACT
Background: COVID-19 is associated with arterial thromboembolism, including acute ischaemic stroke (AIS). An association with antiphospholipid antibodies (aPL) has been noted;however, the prevalence of aPL and their clinical relevance in COVID 19-associated AIS are undefined. Aim(s): The aim was to assess the prevalence, subtypes and persistence of aPL in COVID-19- associated AIS. Method(s): We retrospectively reviewed AIS patients consecutively admitted to the Hyperacute Stroke Unit, University College London Hospitals, during local COVID-19 admission waves (18-Mar- 2020 to 31-May- 2020 and 01-Dec- 2020 to 24-Feb- 2021). Electronic patient records were reviewed for relevant study data, including COVID-19 and aPL status (in accordance with international consensus criteria). Result(s): 380 patients with AIS were identified (median age 74 years, range 24-99);35/380 (9.2%) had active/recent COVID-19 infection (median age 79 years, range 37-93). 132/380 patients were further analysed (those <=65 years), including 11/132 with COVID-19- associated- AIS. Overall, 105/132 (79.5% [including 31/32 (97.9%) patients < 50]), were screened for aPL, of which 26/105 (24.8% [including 7/31 (22.6%) patients < 50]) were aPL positive. In patients with AIS that were screened, aPL prevalence was significantly higher in those associated with COVID-19 than those not associated with COVID-19: 10/11 (90.9%) vs. 16/94 (17.0%), p< 0.05 (Fisher's exact test). Within the COVID-19 AIS group, 8/10 aPL positive patients had an isolated lupus anticoagulant (LA);1/10 was double aPL positive. Five of 10 patients with COVID-19- associated AIS underwent repeat aPL assessment: aPL were persistently positive beyond 12 weeks in 1/5, and transient in 4/5. In the non-COVID- 19 AIS group, 7/16 underwent repeat aPL testing, with 4/7 (57.1%) demonstrating persistence. aPL subtypes are shown in Table 1. Conclusion(s): Among AIS patients, aPL, mainly LA, are more frequent in those with COVID-19 infection. Patients with AIS (with or without COVID-19) found to have aPL should be retested for aPL persistence, potentially leading to a diagnosis of antiphospholipid syndrome.
ABSTRACT
Background and Aims: As a consequence of the COVID-19 pandemic prehospital video assessment (PHVA) of possible stroke was commenced by University College London Hospital and London Ambulance Service. We compared the accuracy of this assessment tool against conventional screening with FAST. Methods: We examined the accuracy of PHVA from May 2020 to April 2021, together with final diagnoses, timings for treatment provided and ambulance crew primary assessment (FAST status) wherever this was recorded. Results: Of 1300 patients triaged, 600 (46%) were sent to HASU, 570 (44%) were AE diverts and 65 (5%) were sent to their local TIA clinic. 40 patients (3%) were returned to their LAS pathway and missing data was noted for 25 patients (2%). From 426 patients where FAST status was recorded, diagnosis of likely stroke/TIA was correct in 89% (278) of PHVA versus 55% (173) of FAST assessed cases. Correct identification of non-stroke was correct in 84% (96) of PHVA versus 65% (75) of FAST assessed cases. A positive predictive value of 93% (PHVA) versus 59% (FAST) and negative predictive value 96% (PHVA) versus 84% (FAST) is noted. 46 thrombolysis and 12 thrombectomy cases with median treatment time before and during PHVA of 35 minutes (Interquartile range (IQR)-26) vs 33 (IQR-15) and 136 (IQR-87) vs 125 (IQR-49) minutes respectively, were noted. Conclusions: PHVA has been validated further, showing superior accuracy to the existing FAST assessment and may improve hyperacute treatment times and their variance.
ABSTRACT
BACKGROUND AND PURPOSE: There are very few studies of the characteristics and causes of ICH in COVID-19, yet such data are essential to guide clinicians in clinical management, including challenging anticoagulation decisions. We aimed to describe the characteristics of spontaneous symptomatic intracerebral haemorrhage (ICH) associated with COVID-19. METHODS: We systematically searched PubMed, Embase and the Cochrane Central Database for data from patients with SARS-CoV-2 detected prior to or within 7 days after symptomatic ICH. We did a pooled analysis of individual patient data, then combined data from this pooled analysis with aggregate-level data. RESULTS: We included data from 139 patients (98 with individual data and 41 with aggregate-level data). In our pooled individual data analysis, the median age (IQR) was 60 (53-67) years and 64% (95% CI 54-73.7%) were male; 79% (95% CI 70.0-86.9%) had critically severe COVID-19. The pooled prevalence of lobar ICH was 67% (95% CI 56.3-76.0%), and of multifocal ICH was 36% (95% CI 26.4-47.0%). 71% (95% CI 61.0-80.4%) of patients were treated with anticoagulation (58% (95% CI 48-67.8%) therapeutic). The median NIHSS was 28 (IQR 15-28); mortality was 54% (95% CI 43.7-64.2%). Our combined analysis of individual and aggregate data showed similar findings. The pooled incidence of ICH across 12 cohort studies of inpatients with COVID-19 (n = 63,390) was 0.38% (95% CI 0.22-0.58%). CONCLUSIONS: Our data suggest that ICH associated with COVID-19 has different characteristics compared to ICH not associated with COVID-19, including frequent lobar location and multifocality, a high rate of anticoagulation, and high mortality. These observations suggest different underlying mechanisms of ICH in COVID-19 with potential implications for clinical treatment and trials.