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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 812--813

Use of poststroke medications and COVID-19-associated mortality

Moon Ho Park1, Dae-Sung Kyoung2,  
1 Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
2 Department of Data Science Analysis, Hanmi Pharmacy, Seoul, South Korea

Correspondence Address:
Dr. Moon Ho Park
Department of Neurology, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-shi, Gyeonggi-do 15355
South Korea




How to cite this article:
Park MH, Kyoung DS. Use of poststroke medications and COVID-19-associated mortality.Neurol India 2022;70:812-813


How to cite this URL:
Park MH, Kyoung DS. Use of poststroke medications and COVID-19-associated mortality. Neurol India [serial online] 2022 [cited 2022 Aug 11 ];70:812-813
Available from: https://www.neurologyindia.com/text.asp?2022/70/2/812/344614


Full Text



Sir,

Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and has become a worldwide health threat. Although the major clinical manifestations of COVID-19 are respiratory manifestations, there are experimental findings that suggest an association between SARS-CoV-2 infection and stroke.[1] There are practical recommendations for management of acute ischemic stroke during the COVID-19 pandemics.[2] Like the management of acute ischemic stroke, that of poststroke is also important because numerous poststroke patients reside in convalescent hospitals and nursing homes, where are vulnerable to infection clusters associated with COVID-19, and stroke itself has been identified as both a critical comorbidity for COVID-19 and a high-risk factor for poor prognosis.

However, controversy exists regarding the links between COVID-19 and therapeutics for poststroke and stroke-associated risk factors. For instance, clopidogrel, a P2Y12 receptor adenosine diphosphate (ADP) antagonist, can prevent infection-induced platelet hyperactivity, via ADP signaling, and whether angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, which are used for the treatment of hypertension, and thiazolidinedione, which is used to treat diabetes, can facilitate COVID-19 remains under debate.[2] Additionally, statins have been associated with a lower risk of mortality in COVID-19.[3]

We evaluated the national COVID-19 claim database of South Korea and identified 5,726 patients with PCR-confirmed COVID-19, of whom 140 had died.[4] Our observations revealed no significant relationship between COVID-19-associated mortality and ongoing, poststroke, medication management, after adjusting for clinically relevant potential confounders, including age, sex, and comorbidities. A similar result was consistently observed, both during the overall analysis of all COVID-19 patients and in the subgroup analysis, which was limited to patients with stroke [Table 1].{Table 1}

These results may not be surprising to some. However, given the possibility of an association between stroke and COVID-19-associated mortality, the ongoing treatment of patients should be based on evidence. The results of this study are critical as they suggest that ongoing treatment with the aforementioned critical antiplatelet, anticoagulant, antihypertensive, and antidiabetic agents may proceed without increasing the risk of poor prognosis in the face of COVID-19.

There are several limitations to this retrospective study. The results should be interpreted carefully given the disadvantages associated with a study of this nature.

In conclusion, our study revealed no association between the poststroke medications with an increased risk of mortality among patients diagnosed with COVID-19. During the unprecedented COVID-19 pandemic, the ongoing-treatment of poststroke patients should be provided adequately and continuously.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Garg RK. Spectrum of neurological manifestations in Covid-19: A review. Neurol India 2020;68:560-72.
2Qureshi AI, Abd-Allah F, Al-Senani F, Aytac E, Borhani-Haghighi A, Ciccone A, et al. Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel. Int J Stroke 2020;15:540-54.
3Zhang XJ, Qin JJ, Cheng X, Shen L, Zhao YC, Yuan Y, et al. In-hospital use of statins is associated with a reduced risk of mortality among individuals with COVID-19. Cell Metab 2020;32:176-87.
4Korea Ministry of Health and Welfare, Health Insurance Review & Assessment Service. #opendata4covid19. Available from: https://hira-covid19.net/. [Last accessed on 2020 Apr 15].