Risultati per: Il significato della carica virale e l’effetto del vaccino anti-COVID-19

Stroke, Volume 53, Issue 3, Page 1043-1050, March 1, 2022. For more than a year, the SARS-CoV-2 pandemic has had a devastating effect on global health. High-, low, and middle-income countries are struggling to cope with the spread of newer mutant strains of the virus. Delivery of acute stroke care remains a priority despite the pandemic. In order to maintain the time-dependent processes required to optimize delivery of intravenous thrombolysis and endovascular therapy, most countries have reorganized infrastructure to optimize human resources and critical services. Low-and-middle income countries (LMIC) have strained medical resources at baseline and often face challenges in the delivery of stroke systems of care (SSOC). This position statement aims to produce pragmatic recommendations on methods to preserve the existing SSOC during COVID-19 in LMIC and propose best stroke practices that may be low cost but high impact and commonly shared across the world.

Comunicato del 17/02/2022 n°7

Comunicato del 09/02/2022 n°5

Stroke, Ahead of Print. Despite evidence-based guidelines,1stroke rehabilitation remains underutilized, particularly among women and minorities.2Telerehabilitation is a promising alternative to traditional in-person rehabilitation and offers a novel strategy to overcome access barriers,3which intensified during the COVID-19 pandemic.4A broadband connection is a prerequisite for its wide adoption but its availability varies across the United States (https://broadbandnow.com/national-broadband-map). Little is known about demographic and geographic variation in internet use among stroke survivors. In this study, we sought to compare internet use in a nationally representative sample of individuals with and without stroke.

Stroke, Volume 53, Issue Suppl_1, Page ATP22-ATP22, February 1, 2022. Background:COVID-19 is thought to induce a pro-thrombotic state, which might increase stroke risk. The purpose of this project is to assess stroke severity, type and coagulation markers such as D-dimer, fibrinogen, and CRP in patients with acute ischemic stroke (AIS) and COVID-19, compared to a control group of AIS without COVID-19.Methods:We captured discharge diagnosis of all patients at our medical center with AIS and COVID based on their discharge ICD-10 coding between June 2020 and May 2021; and identified AIS without COVID matched for age, sex, race, and ethnicity. Group 1 was AIS with COVID-19, Group 2 matched (3:1) AIS without COVID-19. We compared baseline demographics, NIHSS, D-dimer, fibrinogen, CRP, presence of large vessel occlusion (LVO) in COVID-19 AIS vs non-COVID-19 AIS. We used a T test to compare parametric and Mann Whitney U for non-parametric values.Results:In total 23 (of 397 total AIS) patients were in Group 1; 69 in Group 2. D-dimer levels (mean) were 3237.3 in Group 1, and 2706.8 in Group 2 (NS), Fibrinogen 464.4 and 379.8 (NS), CRP 7.9 and 9.4 (NS). Median NIHSS was 21 versus 5 (p=0.003). LVO was present in 17 patients in Group 1 (73%) and 23 (33%) in Group 2 (NS). In total, only 5.8% (23 of 397) of all AIS in our data had Covid-19 infection.Conclusion:COVID in stroke was an infrequent finding in our sample (5.8%). Patients with COVID and stroke had higher initial stroke severity, but did not differ in coagulation values. Weather coagulation markers can help distinguish patients with COVID related stroke will require subsequent studies. We need additional data before treatment recommendations specific to stroke in COVID can be made.

Stroke, Volume 53, Issue Suppl_1, Page ATP26-ATP26, February 1, 2022. Introduction:The coronavirus disease 2019 (COVID-19) pandemic has changed the medical use of stroke patients. This study evaluated the health-seeking behavior of stroke patients and changes in stroke care services at the time of three domestic COVID-19 outbreaks in Korea using the Korean Stroke Registry (KSR) data.Methods:We reviewed data from patients with acute stroke and transient ischemic attack (TIA) from Jan 2019 to May 2021. There were three domestic COVID-19 outbreaks (1st: Feb to Mar 2020, 2nd Aug to Sep 2020, 3rd Nov 2020 to Jan 2021). Outcomes included patient characteristics, times from stroke onset to hospital arrival, and in-hospital stroke pathways.Results:The study included 34,271 patients who visited hospitals that contribute to the KSR. In the first outbreak, in Daegu city (the main epicenter), the number of patients decreased by two-thirds compared to the pre-COVID period, and the number of TIA patients was particularly decreased (9.97% to 2.91%). Unlike other regions, the median onset-to-door time increased significantly in the epicenter (361 min vs. 526.5 min, p=0.016), and longer times were common for patients with mild symptoms and who were in their 60s or 70s. The median onset-to-door time increased in the epicenter during the second outbreak, but it was not statistically significant. At the third outbreak, the median onset-to-door time was reduced even in the epicenter compared to the previous one. The number of patients decreased with each outbreak compared to the previous one, but the decrease gradually became smaller.Conclusions:Korean stroke patients in a COVID-19 outbreak region showed clear changes in health-seeking behaviors and showed a pattern of adaptation to the COVID-19 environment. There is a need for continued attention to an appropriate triage system and public education on the importance of early treatment during the COVID-19 pandemic.

Stroke, Volume 53, Issue Suppl_1, Page ATP24-ATP24, February 1, 2022. Objectives:Evidence suggests an association of increased cerebrovascular accidents frequency in patients diagnosed with the novel coronavirus disease, COVID-19. Coagulopathy resulting from the 2019 novel coronavirus (SARS-CoV-2) infection is suspected. This study aims at evaluating thrombotic markers in relation to stroke severity and functional outcomes in a patient cohort of acute ischemic stroke (AIS) with concurrent COVID-19.Methods:We performed a retrospective observational cohort study of 28 patients who tested positive for SARS-CoV-2 via polymerase chain reaction and concomitant AIS confirmed by brain imaging. We analyzed data regarding initial stroke presentation, markers of coagulopathy, and 90-day functional outcomes.Results:The patient cohort displayed high rate of comorbidities with 78.6% having at least 1 vascular risk factor. NIHSS had a median of 16 at initial presentation and median stroke volume of 52 mL. Median NIHSS at discharge or prior to death was 19, and median 90-day mRS was 4. Highest fibrinogen level recorded showed a median of 759.54 mg/dL (IQR 653.75-940.75), D-dimer and lactate dehydrogenase (LDH) showed a median highest recorded value 24,106 ng/mL (IQR 6105.00-80165.00) and 442 ng/mL (IQR 277.00-545.50), respectively. LDH (p=0.0008), D-dimer (p=0.001), and maximum fibrinogen levels (p=0.049) near the time of stroke significantly predicted final NIHSS and functional outcome 90-days after discharge.Conclusions:Adult patients with acute ischemic stroke and concurrent COVID-19 disease exhibited abnormally high markers of coagulopathy, and LDH, D-Dimer, and fibrinogen levels were predictors of morbidity and neurological disability at 90-days in this patient population. Further research is necessary to establish a definitive pattern and assess the ability to use these markers as prognostic elements of 90-day functional outcome.

Stroke, Volume 53, Issue Suppl_1, Page A54-A54, February 1, 2022. Background:COVID-19, being a prothrombotic state, has been linked to ischemic infarcts. Pooled data on impact of COVID-related stroke on mortality are sparse. We conducted a meta-analysis to assess the risk of stroke-related inpatient mortality (SRIM) during the COVID pandemic vs. pre-pandemic.Methods:Pubmed/Medline, SCOPUS & EMBASE were searched for articles till August 2021 reporting stroke and SRIM during COVID-19 pandemic vs. pre-pandemic. Random-effects model for odds ratio (OR), I2statistics for heterogeneity assessment and leave-one-out method for sensitivity analysis were employed.Results:A total of 31 studies with 455,073 stroke hospitalizations; 365253 pre-pandemic and 89820 pandemics (mean age 72 vs 70 yrs) were analyzed. With a comparable distribution of males, AF, and thrombolysis, the meta-analysis showed a nearly 40% higher risk of mortality during pandemic vs. pre-pandemic admissions (OR 1.42, 95%CI:1.06-1.92, p=0.018, I2=98.59). Further subgroup analysis showed a slightly higher risk of mortality in cohorts with mean age

Stroke, Volume 53, Issue Suppl_1, Page ATMP21-ATMP21, February 1, 2022. Background:Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities.Methods:We analyzed CDC National Vital Statistics System and COVID Data Tracker data from 2017-2020. The primary outcome was age-adjusted stroke (ischemic and hemorrhagic) mortality rate per 100,000. The secondary outcome was % change in state-level stroke mortality rates in 2020 (vs. 2017-19); we report its correlation with state-level 1) prevalence of confirmed COVID-19 infections by 12/31/2021, 2) total COVID mortality by 12/31/20, and the 2020 average state-level % of 3) hospital and 4) ICU beds occupied by COVID-19 patients.Results:Figure 1A shows the typical seasonal decline in stroke mortality in quarters 2/3 was attenuated in 2020. The % change in state-level stroke mortality in 2020 (Figure 1B) was not correlated with prevalence of COVID-19 infection (rho=0.05, p=0.74), mortality (rho=0.10, p=0.49), or the % of ICU beds occupied by COVID-19 patients (rho=0.24, p=0.09). There was a correlation with % of hospital beds occupied by COVID-19 patients (rho=0.35, p=0.01) (Figure 2).Conclusion:Overall stroke mortality increased in 2020, particularly in Q2/3, the early-to-mid phase of the COVID-19 pandemic. At the state level, the average % of all hospital beds occupied by COVID-19 patients in 2020 was the only COVID-19 metric associated with change in stroke mortality. Future work should determine if this association was due to decreased hospital capacity to deliver standard stroke care.

Stroke, Volume 53, Issue Suppl_1, Page ATMP16-ATMP16, February 1, 2022. Introduction:Findings of association between COVID-19 and stroke remain inconsistent, ranging from significant association, absence of association to less than expected ischemic stroke among hospitalized patients with COVID-19. The present study examined the association between COVID-19 and risk of acute ischemic stroke (AIS).Methods:We included 19,553 Medicare fee-for-service (FFS) beneficiaries aged ≥65 years diagnosed with COVID-19 between April 1 and November 30, 2020 and AIS hospitalization from January 1, 2019 through November 30, 2020. We used a self-controlled case series design to examine the association between COVID-19 and AIS and estimated the incident rate ratios (IRR) by comparing incidence of AIS in risk periods (0-3, 4-7, 8-14, 15-28 days after diagnosis of COVID-19) vs. control periods.Results:Among 19,553 Medicare FFS beneficiaries with COVID-19 and AIS, the median age at diagnosis of COVID-19 was 80.5 (interquartile range 73.6-87.3) years and 57.5% were women. IRRs at 0-3, 4-7, 8-14, and 15-28 days following COVID-19 diagnosis were 10.97 (95% confidence interval 10.30-11.68), 1.59 (1.35-1.87), 1.23 (1.07-1.41), and 1.06 (0.95-1.18), respectively. The association appeared to be stronger among younger beneficiaries and among beneficiaries without prior history of stroke but largely consistent across sex and race/ethnicities.Conclusions:Risk of AIS among Medicare FFS beneficiaries was ten times as high during the first 3 days after diagnosis of COVID-19 as during the control period and the risk associated with COVID-19 appeared to be stronger among those aged 65-74 years and those without prior history of stroke.

Stroke, Volume 53, Issue Suppl_1, Page ATP25-ATP25, February 1, 2022. Hypothesis:Hospital presentation for acute stroke may have been delayed during COVID-19. We hypothesize that stroke patients with mild symptoms (NIHSS

Stroke, Volume 53, Issue Suppl_1, Page ATMP22-ATMP22, February 1, 2022. Background and Purpose:Stroke is a serious complication of COVID-19. However, the risk factors for this complication are poorly understood. We hypothesize that genetic predisposition to cardio- and cerebrovascular disease (CVD) leads to an increased risk of stroke in patients with COVID-19 infection.Methods:We evaluated data from a nested cohort study conducted within the UK Biobank focused on persons with documented COVID-19. Incident strokes (ischemic and hemorrhagic) were identified by combining inpatient data (including critical care and discharge diagnostic codes) and primary care data, the latter entered by providers within 30 days of a positive COVID-19 test. Genetic predisposition to CVD was evaluated through a polygenic risk score that integrated genomic information on 2,176 independent genetic risk variants for stroke, coronary artery disease and cardiometabolic risk factors. This score was divided into low (0-20thpercentile), intermediate (20th-80thpercentile), and high (80th-100thpercentile) genetic risk.Results:A total of 11,882 study participants (mean age 65.8, SD [8.6], female sex 6,306 [53.1%]) with documented COVID-19 infection were included in this study, including 99 (0.8%) persons that sustained a stroke during the infection. Compared to persons with low genetic predisposition to CVD, those with intermediate and high genetic risk had 35% (OR 1.35, 95%CI 1.14-1.55) and 2.4-fold (OR 2.38, 95% CI 1.71-3.05) higher risk of stroke (test for trend p=0.004). Sub-scoring analyses evaluating one polygenic risk score per CVD trait of interest indicated that genetic predisposition to hypertension (p=0.017) and smoking (p=0.03) were the most important genetic risk factors.Conclusions:Genetic predisposition to CVD is associated with a higher risk of stroke in persons with acute COVID-19 infection. Genetic risk factors for hypertension and smoking appear to mediate a significant portion of this association. Genetic information should be considered in the multiple ongoing efforts to create risk-stratification strategies to identify COVID-19 patients at high risk of stroke.

Stroke, Volume 53, Issue Suppl_1, Page AWMP53-AWMP53, February 1, 2022. Introduction:Venous thromboembolism (VTE) is a common medical complication following acute ischemic stroke (AIS). Studies have suggested that VTE rates were higher among patients with a history of COVID-19. We examined the risk of VTE in AIS patients with and without a history of COVID-19 among Medicare beneficiaries.Methods:We identified Medicare fee-for-service (FFS) beneficiaries aged ≥65 years with AIS hospitalizations from 04/01/2020 to 06/30/2021. COVID-19 cases were identified by the first diagnosis of COVID-19 on a claim at any health care setting. We defined AIS with COVID-19 if the dates of COVID-19 diagnoses were earlier than AIS admission dates. To identify VTE for each AIS admission, we used the following secondary diagnoses codes: ICD-CM-10: I80, I81, I82, I26. We compared the prevalence ratio (PR) of VTE between AIS patients with and without a history of COVID-19.Results:Among 178,830 Medicare FFS beneficiaries with AIS admissions, 6.1% had a history of COVID-19 and 2.6% had VTE as a complication. VTE prevalence among AIS patients with a history of COVID-19 was 3.98% (95% confidence interval (CI), 3.62-4.36%) and 2.53% (95% CI, 2.46-2.61%) among patients without a history of COVID-19. The adjusted PR of VTE was 1.55 (95% CI, 1.40-1.70, p50% increased risk of VTE than those without a history of COVID-19 (Adjusted PR, 1.59, 95% CI, 1.42-1.78 for Non-Hispanic White, 1.58, 95% CI, 1.28-1.94 for Non-Hispanic Black, p

Stroke, Volume 53, Issue Suppl_1, Page ATP30-ATP30, February 1, 2022. Introduction:Human subjects research requires the retention of enrolled patients in order to provide accurate data. The COVID-19 pandemic introduced unique challenges for clinical trial coordination. AtRial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) is an NIH StrokeNet national clinical trial designed to test superiority of apixaban over aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. We sought to explore the methods that allowed our site to maintain a high retention rate in our local ARCADIA population.Methods:Prior to COVID-19, our trial coordinator (JP), conducted home visits to enroll and complete study visits every 3 months for the first year. This was approved by our local institution, IRB and study sponsor. During COVID-19 precautions, phone contact was maintained and encouraged. Face-to-face visits were not possible, but our coordinator continued to deliver study drug while maintaining distancing precautions. This was followed by a phone call to remind patients of drug instructions and dosages, and inquiring about any adverse events that may have occurred since the last visit. We evaluated the number of follow up visits before and during the COVID lockdown (March through June 2020).Results:Enrollments decreased during the pandemic, in large part due to a study-wide pause in recruitment efforts. The median monthly follow-up prior to COVID-19 was 3, and increased to 5 during lockdown. Before, during and after COVID, our local retention rate has remained 100%.Conclusions:In conclusion, despite complicating factors of COVID-19, our local coordinator’s retention rate remained 100% during the COVID-19 pandemic and our median number of monthly follow up visits increased, which may be attributable to our coordinator’s efforts of socially distanced home visits and frequent communication.

Stroke, Volume 53, Issue Suppl_1, Page AWMP1-AWMP1, February 1, 2022. Approved thrombolytic agents are limited in their use for the treatment of acute ischemic stroke (AIS) due to their benefit-risk profile beyond 4.5 h since last known normal (LKN). TMS-007 is a small molecule, SMTP family member with a novel mode of action: promotion of plasminogen-fibrin binding to enhance physiological thrombolysis while inhibiting inflammation at the site of thrombosis. TMS-007 may extend the treatment time window based on nonclinical pharmacological evidence. We evaluated TMS-007 in a randomized, placebo-controlled, double-blind, dose-escalation phase 2a study. TMS-007 or placebo was administered as a single intravenous infusion at a dose of 1, 3, or 6 mg/kg to AIS patients who were ineligible for t-PA or thrombectomy within 12 h of LKN. The number of patients allocated to placebo and TMS-007 at doses 1, 3, and 6 mg/kg were 38, 6, 18, and 28, respectively. The combined TMS-007 dosing group (Group T; n = 52) was compared with placebo group (Group P; n = 38). The average age was ~72 years old and time since LKN to treatment was ~9 h in both groups (not significantly different). The incidence of symptomatic intracranial hemorrhage (ICH) with worsening NIHSS score of