COVID-19 infection makes stroke risk 7 times higher

Compared to another viral infection like Influenza (the flu), the chance of having a stroke related to a COVID-19 infection is seven times higher.

Is COVID-19 a risk factor for stroke?

Based on recent evidence, this is absolutely true.

Through many publications, the rate of stroke patients during COVID-19 infection ranged from 0.9 to 2.7% (average 1.2%). Compared to another viral infection like Influenza (the flu), the chance of having a stroke related to a COVID-19 infection is seven times higher.

Research published at the American Stroke Conference 2022 found that the risk of stroke was highest in the first 3 days after being diagnosed with COVID-19 (10-fold increase). The risk of stroke decreased gradually over periods of 4-7 days, 8-14 days, and 15-28 days. After a period of 1 year, although significantly lower, the risk of stroke was still higher in people with a previous history of COVID-19 infection.

Why can COVID-19 infection cause a stroke?

COVID-19 can cause ischemic stroke by 3 main mechanisms:

One is the mechanism of increased inflammatory response, leading to inflammation of blood vessels.

The second is to cause hypercoagulability, leading to the formation of thrombus in the arterial system, venous system and organs.

The third is retrograde thromboembolism, especially in patients who still have the foramen ovale PFO – a common hole between the two chambers of the heart.

A small number of documents show that coronavirus infection can cause vasoconstriction, increased blood pressure leading to cerebral hemorrhage.

Are stroke patients related to COVID-19 different from other causes?

Through meta-analysis, it was found that patients with COVID-19-related stroke had more severe neurological deficits. However, the possibility that the symptoms while being infected with COVID-19 can make the situation worse. Mortality rates can be as high as 38%. The median age of stroke in patients with COVID-19 is 63, although many strokes have been reported in young COVID patients.

A higher incidence of major arterial occlusion was observed, especially in the group of thromboembolism of unknown origin.

How to prevent stroke in COVID19 patients in the post-infection period?

People after COVID-19 infection 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-19 patients has involved only tight control of risk factors. There is no evidence to suggest the effectiveness of anticoagulants or antiplatelet agents in primary stroke prevention.

For patients who have had a stroke and concomitant post-COVID-19 infection, the use of anticoagulation or antiplatelet therapy should be maintained. Selection will depend on the underlying mechanism of the stroke, and should not be switched to anticoagulation solely because of post-COVID-19 infection.

Should stroke screening after COVID-19 infection?

If you have a mild case of COVID-19 with no associated stroke risk factors, your risk of stroke will be very low, and there is no need for routine stroke screening.

If other risk factors are present, stroke screening should also focus on the goal of tight control of these risk factors. Imaging techniques should not be abused if the patient has no symptoms of stroke.

Most people were panicking because of the pandemic and the media noise. Therefore, it is the doctor’s duty to calm them down and help them regain their composure. Don’t make them suffer any more with post-COVID-19 screening packages.