The number of stroke sufferers during the Covid period was 0.9-2.7%, 7 times higher than other viral infections such as influenza (influenza), but after Covid, screening should only be done if there are muscle risk factors.
Associate Professor, Doctor, Doctor Nguyen Huy Thang, Vice Chair of the Vietnam Stroke Association, Head of Department of Cerebrovascular Diseases 115 People Hospital (HCMC), said as above, on March 26. The study was recently published at the 2022 American Stroke Conference. The study also showed the highest stroke risk, increasing tenfold in the first three days after being diagnosed with Covid-19. The risk gradually decreases at intervals of 4-7 days, 8-14 days, and 15-28 days. After one year, although significantly lower, patients with a previous history of Covid still had an increased risk of stroke.
Why can Covid cause a stroke?
According to Associate Professor Thang, Covid can cause ischemic stroke through three main mechanisms. first is an increase in the inflammatory response, causing inflammation of the blood vessels. SecondCovid causes hypercoagulability, which leads to thrombus formation in the arterial system, venous system and organs. Tuesday is a retrograde thromboembolic mechanism, especially in patients with residual oval fistula in the heart (PFO). A small number of documents show that nCoV infection can cause vasoconstriction, an increase in blood pressure leading to cerebral hemorrhage.
How is stroke related to Covid?
A meta-analysis showed that patients with Covid-related stroke had more severe neurological deficits. However, it is possible that the symptoms of having Covid made the general condition worse. The average age of stroke sufferers in Covid patients is 63 years, some stroke cases are in young patients. A higher incidence of major arterial occlusion was observed, especially in the thromboembolic group of unknown origin. The test results also show hypercoagulability.
Treatment of acute stroke related to Covid
Stroke experts recommend not changing current care for stroke patients who have or are currently suffering from Covid. This means that doctors should not skip standard treatments such as intravenous thrombolysis or mechanical thrombectomy if the patient is eligible.
Post-Covid stroke prevention
The following Covid patients are considered a high risk group for stroke when they have many other risk factors such as high blood pressure, diabetes, lipid metabolism disorders, smoking, obesity … to date, primary stroke prevention in post-Covid patients is only about control strict risk factors. Clinicians do not yet have evidence that anticoagulants or antiplatelet agents are effective for primary stroke prevention.
Patients who have had a concomitant stroke after being infected with Covid, doctors recommend that they continue to use anticoagulants or antiplatelet agents, depending on the mechanism of the previous stroke, should not switch to anticoagulants just because of the side effects of being infected with Covid.
Should post-Covid stroke screening be done?
Patients with mild Covid, with no associated stroke risk factors, have a very low risk of stroke. Therefore, there is no need for routine stroke screening.
In patients with other associated risk factors (high blood pressure, diabetes, smoking, obesity…), stroke screening focuses on tightly controlling these risk factors. Imaging techniques should not be abused if the patient does not have stroke symptoms.