Clinical features of patients with cryptogenic stroke and COVID-19

Introduction: While coronavirus disease 2019 (COVID-19) has been associated with acute ischemic stroke (AIS), the causal relationship has yet to be elucidated Factors that likely confer increased stroke risk are COVID-19-associated coagulopathy and hyperinflammatory response Studying clinical features of patients with otherwise undetermined cause of AIS could help better define COVID-19-associated stroke Methods: We performed a multicenter cross-sectional study of consecutive patients presenting with AIS and COVID-19 to one of two large healthcare systems in New York City during the local COVID- 19 surge from March 1, 2020 to May 31, 2020 In-hospital stroke cases were excluded We compared demographic and clinical features of patients with COVID-19 and a cryptogenic AIS subtype to patients with COVID-19 and a determined subtype Baseline characteristics and clinical variables were compared using chi-squared and Fisher exact tests Results: A total of 62 patients with AIS and COVID-19 at the time of hospital arrival were identified Of these, 30 were classified as having a cryptogenic subtype (80% after complete diagnotics evaluation), and 32 had an identifiable stroke mechanism Patients with cryptogenic AIS were significantly younger (p=0 011) and less likely to have co-morbid hypertension (p=0 019), coronary artery disease (p=0 024), heart failure (p=0 039), atrial fibrillation (<0 0001), and prior stroke or TIA (p=0 033) compared to those with defined mechanisms Further, d-dimer, but not C-reactive protein, was significantly higher in patients with cryptogenic stroke compared to those with defined causes (p=0 009) Conclusion: Patients with AIS in the setting of COVID-19 and no other determined stroke mechanism were younger, less likely to have classic risk factors, and had higher d-dimer levels when compared to those with a determined mechanism Further study of COVID-19-associated hypercoagulability as a mechanism of stroke is warranted