COVID-19 Exposures, Vaccines, and Acute Ischemic Stroke Risk: On Balance and in Balance

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Most stroke prevention strategies involve optimizing medication regimens, diet, activity, lifestyle, and behavioral changes to promote cerebrovascular and cardiovascular health.1 However, soon after the World Health Organization declared the SARS-CoV-2 infection COVID-19 a global pandemic, it became more apparent that SARS-CoV-2 infection would become an unignorable risk factor for stroke.2 Patients with COVID-19, particularly severe respiratory manifestations of the disease, were found early on to have evidence of a prothrombotic and proinflammatory state along with a propensity for cardiac dysfunction and stroke.3 Stroke incidence in patients with COVID-19 was particularly higher in those with cardiovascular risk factors but could also occur in younger patients and those without preexisting traditional cardiovascular risk factors.2 After the advent of COVID-19 vaccines, there emerged similarly concerning case reports of thrombotic events such as acute ischemic stroke (AIS) and cerebral venous thrombosis post-COVID-19 vaccine exposure, potentially resulting from thrombotic thrombocytopenia syndrome (TTS), cardiac dysfunction, or an excess of the vaccine-induced immune response.4-7 As the pandemic evolves to endemic and repeated "booster"doses of vaccine are inevitably needed to stave off severe COVID-19 illness, these events obligate us to weigh the stroke risks from COVID-19 infection against the stroke risks from COVID-19 vaccination.




Simpkins, A. N., & Cheng, S. (2022, October 4). COVID-19 Exposures, Vaccines, and Acute Ischemic Stroke Risk: On Balance and in Balance. Neurology. Lippincott Williams and Wilkins.

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