OBJECTIVES: An increased risk of thrombotic or cerebrovascular complications has been documented in patients with acute COVID-19. It is not yet known if an increased risk of stroke is true for patients in long-term recovery from severe hospitalised COVID-19. This systematic literature review (SLR) aimed to assess the onset of cerebrovascular events (including stroke) in patients with post-COVID-19 syndrome ≥4 weeks following hospitalisation for severe COVID-19 infection.

METHODS: Embase, MEDLINE and Cochrane were searched from January 2020 to June 2021 to identify relevant clinical studies reporting the incidence of post-discharge cerebrovascular events following a severe COVID-19 infection. Supplementary sources including conferences, reference lists and key organisation websites were scanned. The SLR was conducted in accordance with the PRISMA and Cochrane guidelines.

RESULTS: A total of four studies were included from 3,789 identified articles. Two studies were conducted in the USA, one in Ukraine and one in Iran. Three studies had a short follow-up period and were conducted between February 2020 to May 2020; while one study reported data up to January 2021. Post-discharge timepoints ranged from 30 to 90 days. The incidence of stroke varied across the studies, ranging from 0.45% to 11.5%. Unsurprisingly, the study with the longest follow-up period reported the highest incidence of cerebrovascular events. Considering that limited data is available till date for patients with post-COVID-19 syndrome, newly published findings (via hand searching) from ongoing studies may be further included to minimise the paucity of evidence currently available.

CONCLUSIONS: Despite the large number of peer-reviewed articles associated with the COVID-19 pandemic, there is limited published evidence demonstrating the incidence of stroke in patients who have recovered from severe COVID-19. Several studies are ongoing, and much-needed evidence is awaited from longitudinal studies that may document the risk of stroke in patients with post-COVID-19 syndrome.