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Stroke under 50 may be COVID-related clotting

Lankenau Medical Center May 18, 2020 General Wellness

During COVID-19 the guidance from physicians has been for patients with cardiovascular problems to be mindful of the heightened risk of contracting the coronavirus and having complications from it.  A weaker heart seems to be particularly susceptible to problems related to COVID. Heart patients also commonly have risk factors such as high blood pressure or high cholesterol and may have had a stroke in the past. 

During COVID, emergencies are still emergencies and stroke is an emergency. Recognize stroke and think F.A.S.T. Is the person’s Face drooping? Can they lift both Arms? Is their Speech slurred and can they understand you? And Timing is critical, to call for help.

If you or a loved one is experiencing stroke symptoms, you should always notify 911 and report to your local emergency room. Early treatment for stroke is critical to reduce long-term disability.

The link between COVID and stroke risk

The average age for stroke and heart attack is over 65 years old. So it came as some surprise when five patients under the age of 50 were treated for stroke within a two-week time period at Mount Sinai Health System in New York City. The age of patients was reason enough for surprise, but doctors learned more when they looked more closely at each case. 

Each patient tested positive for coronavirus yet had shown only mild symptoms of the virus, if any, leading up to the stroke. Additionally, while none of them had any of the usual risk factors for stroke like high blood pressure or cholesterol, they each had abnormal clotting, an unusual finding in younger patients with no other stroke risk factors. 

“Abnormal clotting appears to be the blood vessels’ response to the invading virus in some patients,” according to William A. Gray, MD, cardiologist and president of Lankenau Heart Institute and president American Heart Association Philadelphia chapter. Clot formation in the arteries of the body can interrupt the delivery of oxygen to the organs, whether that clot affects large vessels or the tiny capillary vessels. Without this effective blood flow and transfer of oxygen, heart and brain function are negatively affected and can be permanently damaged (heart attack and stroke, respectively). Clotting can also occur in the veins and lead to deep vein thrombosis (DVT) in the legs, causing swelling and pain. If a clot breaks off from a DVT and travels to the lungs it can cause a pulmonary embolism (PE), which can cause breathing problems and even death in severe cases.

Dr. Gray elaborates further, saying there’s a receptor cell called ACE2, which is found in our blood vessels throughout the body, including the heart, lungs and intestines. ACE2 receptors are the gateway into our cells for the coronavirus. When the virus binds to these ACE2 receptors, it activates our immune system which in turn leads to inflammation as the immune system fights the virus, but which can also cause clots to form. The immune system is doing what it is supposed to do but the cells that are needed to stop clot formation do not get sufficiently activated. Your ACE2 receptor levels is likely a genetic function but also may be affected by certain types of medication.

Gray explains, “So this inflammatory response to viral infection and the resultant clotting may point to why we’re seeing strokes in this younger age range. This is also new territory for the medical and scientific communities to explore viral infection as a possible cause for stroke in patients of any age.”

While this is new territory, it’s evolving rapidly. Over the past several weeks, hospitals across the country have seen so many coronavirus patients that have presented with clotting issues, there’s now a name for it: COVID-19 coagulopathy or CAC. In response to the rise in CAC cases, it’s become standard practice to administer blood-thinning medications (anticoagulants) to people who test positive for coronavirus in the emergency room to reduce stroke risk.
 
“Timing is still critical when it comes to treating stroke,” adds Dr. Gray. “There are powerful intravenous clot-busting medications that improve long-term disability after stroke but they must be administered within four-and-a-half-hours of when the stroke first started. And both during and after that time frame, we can often perform brain-preserving and life-saving procedures such as thrombectomy, where we are able to actually exact the clot that is causing the stroke with a tiny catheter system. For these therapies to provide the most benefit, the sooner we can see you the better.”

Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form. Main Line Health is a proud sponsor of the American Heart Association’s Go Red For Women campaign.