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

Seabra, Carolina; Silva, Bárbara; Fagundes, Vítor; Rocha, João; Nogueira, Luís; Mesquita, Mari

INTRODUCTION: 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. CASE DESCRIPTION: 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. DISCUSSION: 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. LEARNING POINTS: 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.