Association between COVID-19 Infection and Thrombotic Stroke: A Systematic Review

Coronavirus disease (COVID-2019) is a global epidemic and emergency that has caused significant changes in health care systems. The previous studies have reported an increased risk of thromboembolic events, including stroke, in patients with COVID-19. This systematic review was performed to describe the frequency, clinical features, and cognitive function of patients with thrombotic stroke and COVID-19 infection.

The articles were searched based on the search strategy considered in the main databases of Google Scholar, PubMed, and Science Direct for the relevant manuscripts in the period from November 2019 to July 2021. The selected articles were considered based on criteria such as patient's age, time of onset of stroke, previous disease history, symptoms, inflammatory markers, drugs used, and final fate of patients.

Out of 1672 articles obtained from the initial search, 26 articles had inclusion criteria and were therefore included in the final analysis. The results of the study showed that the frequency of stroke and mortality in older people with COVID-19 infection is higher than in other ages. However, when systemic symptoms are severe, young people are prone to neurological complications. The Previous history of underlying diseases increased the severity and frequency of the disease. The onset of stroke varied from 2 hours to 4 weeks after the first symptoms of COVID-19. Furthermore, the symptoms of the disease appear in patients in more or less various forms, which are somewhat improved by the use of SARS- COV-2 suppressive drugs, prophylactic and anti-clotting drugs. Finally, the increased risk of ischemic stroke is probably multifactorial and is reflected by activation of coagulation and inflammatory pathways, increased levels of D- dimer, C- reactive protein, thrombin, fibrin, red blood cell deposition, lactate dehydrogenase, and lymphopenia.

Although most patients with COVID-19 have a predominantly respiratory infection, some patients develop venous and arterial thromboembolic complications that can lead to stroke. However, further studies are needed to provide stronger estimates of the increased risk of stroke due to COVID-19 infection and to elucidate the exact pathophysiology of the SARS- COV-2 association with the risk of thrombotic stroke.