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Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724024


Background: Large vessel occlusion (LVO) is the most common stroke subtype for those patient's presenting with COVID-19. Clot perviousness, or a clot's permeability to iodinated contrast, provides insight to an individual's responsiveness of hyperacute revascularization, clot origin and functional post-stroke outcomes. We aimed to calculate LVO perviousness for those with and without COVID-19 and its association with revascularization and outcomes. Methods: This is a retrospective case-control study for individuals presenting with middle cerebral artery (MCA) LVO with and without COVID-19 positivity. Clot perviousness was calculated by a blinded experienced neuroradiologist. Perviousness scores were compared with demographic and comorbidity information as well as revascularization and functional outcomes. Results: 18 individuals with a MCA LVO (9 COVID-19 infected) were included. Those with COVID-19 were significantly more likely to have diabetes mellitus [67% (6/9) versus 11% (1/9), p = 0.05] and hypertension [89% (8/9) versus 22% (2/9), p = 0.02]. Clot perviousness trended lower in the COVID-19 group [11.0 (8.2 - 26.4) versus 31.7 (30.4 - 39.2), p = 0.10]. Those with COVID-19 infection tended to have a lower clot pervious score, [22% (2/9) versus 78% (7/9), p =0.057]. The majority of those presenting with COVID-19 died during the hospitalization. Conclusions: Our data suggests for those with COVID-19 and MCA LVO, clots tended to be more impermeable to iodinated contrast. This finding may be due to the underlying coagulopathy of COVID-19, namely alternations in fibrin homeostasis. (Figure Presented).

Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724004


Background: Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities. Methods: We analyzed CDC National Vital Statistics System and COVID Data Tracker data from 2017-2020. The primary outcome was age-adjusted stroke (ischemic and hemorrhagic) mortality rate per 100,000. The secondary outcome was % change in state-level stroke mortality rates in 2020 (vs. 2017-19);we report its correlation with state-level 1) prevalence of confirmed COVID-19 infections by 12/31/2021, 2) total COVID mortality by 12/31/20, and the 2020 average state-level % of 3) hospital and 4) ICU beds occupied by COVID-19 patients. Results: Figure 1A shows the typical seasonal decline in stroke mortality in quarters 2/3 was attenuated in 2020. The % change in state-level stroke mortality in 2020 (Figure 1B) was not correlated with prevalence of COVID-19 infection (rho=0.05, p=0.74), mortality (rho=0.10, p=0.49), or the % of ICU beds occupied by COVID-19 patients (rho=0.24, p=0.09). There was a correlation with % of hospital beds occupied by COVID-19 patients (rho=0.35, p=0.01) (Figure 2) Conclusion: Overall stroke mortality increased in 2020, particularly in Q2/3, the early-to-mid phase of the COVID-19 pandemic. At the state level, the average % of all hospital beds occupied by COVID-19 patients in 2020 was the only COVID-19 metric associated with change in stroke mortality. Future work should determine if this association was due to decreased hospital capacity to deliver standard stroke care.

Stroke ; 52:2, 2021.
Article in English | Web of Science | ID: covidwho-1367538
Stroke ; 52(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1234409


Introduction: With hundreds of thousands of clinical trial patients enrolled yearly, the COVID-19 pandemic caused a significant, unexpected disruption in clinical trials across the world. US data showed a 70% enrollment reduction in April and a 38% reduction in July 2020, compared to prepandemic rates. We implemented processes during the initial phase of the pandemic to minimize participant and staff viral exposure, develop remote procedures, and ease communication barriers, while still maintaining enrollment goals. Methods: Our stroke research team developed multiple processes to help mitigate pandemic effects on our enrollment. We developed watchlists for eligible and interested patients who could not be enrolled due to national and local restrictions. As research staff was unable to approach patients in person, phone and email scripts were developed to ensure information was disseminated in a consistent fashion. Remote and alternate consent methods were implemented. We tracked the evolving national and local guideline changes, and began re-opening trials on May 23, 2020. We implemented a rotating pool of coordinators, including a site-specific sanitation plan, once it was safe to be on campus in-person. In person meetings were moved to a virtual platform. Enrollment data across for 10 active subacute stroke studies, each active over the 3 years of, 2018-2020, was analyzed for the months from March to June, with 2020 individually compared to 2018 and 2019 via the Student T-Test. Results: Total enrollment during these 4 months were 15 participants in 2018, 11 in 2019, and 15 in 2020, with no statistical difference between the years. No study patients nor staff contracted symptoms of COVID-19. Conclusion: Enrollment shows no significant changes despite COVID-19. New processes allowedthe timely reopening of clinical trials, an overall maintenance of enrollment rates, including a non-significant increase in 2020 compared to previous years. Our telehealth and virtual communicationfocused processes prioritize the safety of patients and staff while ensuring quality control andappropriate enrollment numbers.

Stroke ; 52(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1234365


Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both nontraumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer's exact test and nonparametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%);empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p = <0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

Stroke ; 52(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1234363


Background: Because COVID-19 is thought to be pro-thrombotic and could theoretically increase the severity of cerebral venous sinus thrombosis (CVST), we sought to examine the outcomes of CVST patients with comorbid COVID-19 infection. Methods: We performed a retrospective analysis using the Vizient Clinical Data Base (CDB), a healthcare analytics platform employed by participating US hospitals. We identified CVST with the ICD-10 codes I63.6, I67.6, G08.x, O22.5, and O87.3. We created three cohorts of patients: CVST with confirmed or suspected COVID-19 in April, May or June 2020, CVST with influenza-like illness (ILI) in 2019, and CVST without ILI in 2019. The outcomes are 1) in-hospital death and 2) favorable discharge (discharge destination home or acute rehabilitation). We fit logistic regression models to our outcomes and adjusted for patient age, sex, race/ethnicity, Elixhauser comorbidity score, acute respiratory failure requiring intubation, and hospital length of stay. Results: We identified 73 patients with CVST and COVID-19, 159 with CVST and ILI, and 4,146 with CVST and no COVID-19 or ILI. The patient death rates were 20.6%, 8.8%, and 5.1%, respectively, and favorable discharge rates were 58.9%, 52.8%, and 77.3%, respectively. Compared to CVST patients with ILI, those with COVID-19 were not significantly more likely to die in-hospital (adjusted OR 1.43, 95% CI 0.44-4.66, p=0.557) or to have favorable discharge (adjusted OR 1.75, 95% CI 0.58-5.25, p=0.321). Compared to CVST patients without ILI or COVID-19, those with COVID-19 were also not significantly more likely to die in-hospital (adjusted OR 0.87, 95% CI 0.35- 2.12, p=0.751) or to have favorable discharge (adjusted OR 1.52, 95% CI 0.62-3.69, p=0.358). Conclusion: Although CVST patients with COVID-19 had a higher in-hospital death rate and lower favorable discharge rates, after adjusting for potential confounders there was no association between worse outcomes in CVST patients with COVID-19. This suggests that while CVST may complicate COVID-19, it does not portend a worse prognosis than CVST in patients with either ILI or no ILI or COVID-19.