COVID-19-Related Stroke

Transl Stroke Res. 2020 Jun;11(3):322-325. doi: 10.1007/s12975-020-00818-9. Epub 2020 May 7.

Abstract

The COVID-19 pandemic is associated with neurological symptoms and complications including stroke. There is hypercoagulability associated with COVID-19 that is likely a "sepsis-induced coagulopathy" and may predispose to stroke. The SARS-CoV-2 virus binds to angiotensin-converting enzyme 2 (ACE2) present on brain endothelial and smooth muscle cells. ACE2 is a key part of the renin angiotensin system (RAS) and a counterbalance to angiotensin-converting enzyme 1 (ACE1) and angiotensin II. Angiotensin II is proinflammatory, is vasoconstrictive, and promotes organ damage. Depletion of ACE2 by SARS-CoV-2 may tip the balance in favor of the "harmful" ACE1/angiotensin II axis and promote tissue injury including stroke. There is a rationale to continue to treat with tissue plasminogen activator for COVID-19-related stroke and low molecular weight heparinoids may reduce thrombosis and mortality in sepsis-induced coagulopathy.

Keywords: Angiotensin-converting enzyme 2 (ACE2); COVID-19; Coagulopathy; SARS-CoV-2; Sepsis; Stroke.

Publication types

  • Letter
  • Research Support, N.I.H., Extramural

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • Betacoronavirus / metabolism
  • COVID-19
  • Coronavirus Infections / blood
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology
  • Disseminated Intravascular Coagulation / drug therapy
  • Disseminated Intravascular Coagulation / virology
  • Female
  • Humans
  • Male
  • Pandemics
  • Peptidyl-Dipeptidase A / administration & dosage
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology
  • Recombinant Proteins / administration & dosage
  • SARS-CoV-2
  • Stroke / drug therapy
  • Stroke / virology*
  • Tissue Plasminogen Activator / blood
  • Tissue Plasminogen Activator / therapeutic use

Substances

  • Recombinant Proteins
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2
  • Tissue Plasminogen Activator