COVID-19 research briefs: SARS-CoV-2 may increase stroke rate in patients younger than 50, and remdesivir shortens recovery
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Clinical question
Does SARS-CoV-2 infection increase the risk of stroke in people younger than 50 years? Can remdesivir improve recovery time in people with SARS-CoV-2 infection?
Bottom line
This very small case series indicates that COVID-19 may increase the rate of stroke in people younger than 50 years.
Preliminary data from this large US trial shows shorter recovery tiime in people who received remdesivir (LOE = 4)
Reference
Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med. Published online April 28, 2020. doi: 10.1056/NEJMc2009787.
Study design: Other
Setting: Other
Synopsis
Research Brief #18: This is a case series of the 5 persons with SARS-CoV-2 infection who presented with a large vessel stroke to a health system in New York City during a 2-week period. This is 7 times the usual rate of stroke in persons under age 50 years. Their ages ranged from 33 to 49 years; 2 were otherwise healthy, one had hypertension and hyperlipidemia, one had undiagnosed diabetes, and one had diabetes and a history of mild stroke. The middle cerebral artery was invloved in 3 cases, the posterior cerebral artery in one, and the internal carotid artery in one. All patients were treated with antiplatelet therapy, one also received tissue plasminogen activator, and 4 also received clot retrieval. D-dimer levels were significantly elevated in 3 patients, Two patients delayed seeking care because of fears about COVID-19. All but one patient experienced at least some improvement in their symptoms, and 3 had been discharged by the time the article was written. Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med. Published online April 28, 2020. doi: 10.1056/NEJMc2009787.
Research Brief #19: The National Institute of Allergy and Infectious Diseases (NIAID) has released initial results (non-peer-reviewed; full data not yet available) of the Adaptive COVID-19 Treatment Trial. The study recruited 1063 hospitalized patients with SARS-CoV-2 infection and evidence of lung involvement. The patients were randomized to receive intravenous remdesivir (200 mg on day 1 and then 100 mg daily for up to 10 days or hospital discharge) or matching placebo injection. The primary outcome was time to recovery, which was significantly shorter in the remdesivir group (11 vs 15 days; P < .001). There was also a trend toward lower mortality in the remdesivir group (8.0% vs 11.6%; P = .059; number needed to treat = 28). The authors did not report harms or other outcomes, such as need for mechanical ventilation. A smaller Chinese study in more severely ill patients found no benefit to treatment with remdesivir. National Institute of Allergy and Infectious Diseases. NIH clinical trial shows remdesivir accelerates recovery from advanced COVID-19. Press release published online April 29, 2020.
Copyright © 2020 John Wiley & Sons, Inc.
