Publication date: Jul 01, 2025

We aimed to determine the clinical impact of prior vaccination against Coronavirus Disease 2019 (COVID-19) on COVID-19 infection associated acute ischemic stroke (AIS). Using the TriNetX COVID-19 Research Network, an international electronic health record database, we identified AIS cases admitted between April 1, 2021 and September 30, 2022 that had a COVID-19 diagnosis up to 30 days before hospitalization. The study cohort was divided into two groups: those with and without vaccination against COVID-19. The two groups were matched for demographics, comorbidities, and antithrombotics taken before AIS with 1:1 propensity score matching. Cox proportional hazard analysis was performed to report primary (all-cause mortality) and secondary outcomes at 7 and 30 days after AIS. We identified 3,573 vaccinated (71 +/- 12 (mean +/- SD) years, 49% females) and 46,329 unvaccinated patients (65 +/- 15 years, 45% females) who met the study criteria. After propensity score matching, 3,569 patients were in both groups. Vaccinated individuals had significantly lower rates of all-cause mortality [7 days: 3. 3% vs 5. 0%; HR = 0. 66; 95% CI = 0. 52-0. 83 and 30 days: 8. 2% vs 9. 5%; HR = 0. 83; 95% CI = 0. 71-0. 97], intracranial hemorrhage [7 days: 4. 1% vs 6. 2%; HR = 0. 66; 95% CI = 0. 53-0. 82 and 30 days: 4. 5% vs 6. 7%; HR = 0. 66; 95%CI = 0. 53-0. 81], venous thromboembolism [7 days: 3. 5% vs 7. 8%; HR = 0. 44; 95% CI = 0. 35-0. 56 and 30-days: 4. 6% vs 8. 9%; HR = 0. 51; 95% CI = 0. 41-0. 63] and acute myocardial infarction [7 days: 4. 1% vs 7. 0%; HR = 0. 58; 95% CI = 0. 46-0. 73 and 30 days: 4. 7% vs 7. 6%; HR = 0. 60; 95% CI = 0. 49-0. 75)]. Prior vaccination against COVID-19 is associated with reduced rates of all-cause mortality, intracranial hemorrhage, venous thromboembolism, and acute myocardial infarction within 30 days of COVID-19 associated AIS.

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