Background and Purpose:With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19.Methods:We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls).Results:During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls.Conclusions:We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.

中文翻译：

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纽约医疗保健系统中的SARS-CoV-2和中风。

背景与目的：随着冠状病毒病2019（COVID-19）在当前的全球大流行中蔓延，越来越多的证据表明，受该病影响的患者可能会发展出临床上显着的凝血病，并伴有包括缺血性中风在内的血栓栓塞并发症。然而，关于中风和COVID-19的患者的临床特征，中风机制和结局的数据有限。方法：我们对2020年3月15日之间住院的缺血性中风患者进行了回顾性队列研究， 2020年4月19日，在纽约的一个主要卫生系统中，这是当前全球大流行的中心。我们将同时诊断为COVID-19的中风患者的临床特征与没有COVID-19的中风患者（同期对照）进行了比较。此外，我们将患者与2019年3月15日至2019年4月15日从我们医院系统出院的缺血性中风患者的历史队列（历史对照）进行了比较。结果：在2020年的研究期间，在3556例诊断为脑卒中的住院患者中COVID-19感染的32例患者（0.9％）影像学证实为缺血性中风。与当代对照组（30.4％，P = 0.003）和历史控制（25.0％，P<0.001）。与当代对照组相比，COVID-19阳性患者入院率更高，其国立卫生研究院卒中量表评分较高，D-二聚体峰值水平较高。与历史对照相比，COVID-19阳性患者更有可能是肌钙蛋白升高，入院美国国立卫生研究院卒中量表评分较高和红细胞沉降率较高的年轻男性。结论：我们观察到住院的COVID-19患者的影像学证实缺血性卒中发生率较低。大多数中风是隐源性的，可能与获得性高凝有关，死亡率增加。