Elevated concentrations of cell-free hemoglobin and iron found in cerebral thrombi of stroke patients prior to the Omicron variant: new contributors to the prothrombotic effects of SARS-CoV-2

Category	Detail
Condition	COVID-19-associated ischemic stroke
Key Mechanisms	Hypercoagulable state due to immunothrombosis, endothelial dysfunction, and coagulopathy.
Target Population	Adults with acute ischemic stroke caused by large vessel occlusion.
Care Setting	Hospital settings with mechanical thrombectomy capabilities.

COVID-19 increases the risk of cerebrovascular disease, particularly ischemic stroke.
Acute ischemic stroke occurred in approximately 1.5% of individuals after SARS-CoV-2 infection during the pre-Omicron period.
Cryptogenic etiology is frequent in COVID-19-related stroke, associated with poorer outcomes.
COVID-19 stroke patients exhibit a hypercoagulable state with elevated D-dimer and thrombin generation.
Direct examination of cerebral thrombi reveals distinct molecular signatures of COVID-19-associated immunothrombosis.

Confirm SARS-CoV-2 infection through RT-PCR or serology in patients with acute ischemic stroke.

Mechanical thrombectomy for acute ischemic stroke caused by large vessel occlusion.

Monitor for signs of hypercoagulability and thrombotic complications in COVID-19 patients.

Increased risk of early intracerebral arterial re-occlusion post-thrombectomy in COVID-19 stroke patients.

Adults with acute ischemic stroke and confirmed SARS-CoV-2 infection.

Thrombectomy may be complicated by a hypercoagulable state and higher rates of thrombus re-occlusion.

Utilize multi-technique analysis of cerebral thrombi to identify molecular drivers of prothrombotic states.
Consider the role of immune activation and endothelial dysfunction in managing COVID-19-related strokes.

Clinical Scorecard: Elevated concentrations of cell-free hemoglobin and iron found in cerebral thrombi of stroke patients prior to the Omicron variant: new contributors to the prothrombotic effects of SARS-CoV-2