Should the Management of Embolic Stroke in the Elderly Be Changed if They Also Have COVID-19?

• Published in: European journal of case reports in internal medicine Vol. 7; no. 6; p. 001736
• Main Authors: Seabra, Carolina, Silva, Bárbara, Fagundes, Vítor, Rocha, João, Nogueira, Luís, Mesquita, Mari
• Format: Journal Article
• Language: English
• Published: Italy SMC Media Srl 2020; SMC MEDIA SRL
• Subjects: atrial fibrillation; covid-19; embolism; stroke; COVID-19; atrial fibrillation; stroke; Embolism
• ISSN: 2284-2594; 2284-2594
• DOI: 10.12890/2020_001736

A strong association between stroke and atrial fibrillation (AF) has been demonstrated. Anticoagulation for the prevention of stroke in high-risk patients has the benefit of improving the life expectancy, quality of life, autonomy and social functioning of the patient. The COVID-19 pandemic poses challenges for stroke patients because of the association between SARS-CoV-2 infection and thromboembolic risk.
We describe the case of an 84-year-old female patient admitted due to an embolic stroke and non-anticoagulated AF. Her admission symptoms were sensory-motor aphasia and severe right limb paresis with an NIHSS score of 24. The diagnosis of embolic stroke (namely, total anterior circulation infarct; TACI) was made. Her stroke was extensive so she was not started on anticoagulation. During hospitalization, new embolic events occurred and a concomitant diagnosis of COVID-19 was made with progressive respiratory dysfunction followed by multiorgan failure. The patient died despite appropriate treatment.
The prognosis of elderly patients with cardioembolic stroke depends on anticoagulation administration. The NIHSS score on admission of our patient meant anticoagulation therapy was not appropriate. The diagnosis of COVID-19 contributed to the patient's death.
Anticoagulation should be considered in stroke patients with total infarction and atrial fibrillation.There is an association between COVID-19 and thromboembolic stroke.Elderly patients with stroke and COVID-19 are at higher risk of death.