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Should the Management of Embolic Stroke in the Elderly Be Changed if They Also Have COVID-19?

Carolina Seabra1, Bárbara Silva1, Vítor Fagundes1

  • 1Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.

European Journal of Case Reports in Internal Medicine
|June 12, 2020
PubMed

Insights

Elderly patients with atrial fibrillation (AF) and stroke face high mortality, especially when diagnosed with COVID-19. Anticoagulation is crucial for stroke prevention in AF, but contraindications like severe stroke may limit its use.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • A strong association exists between stroke and atrial fibrillation (AF).
  • Anticoagulation improves outcomes for high-risk stroke patients.
  • COVID-19 increases thromboembolic risk, complicating stroke management.

Purpose of the Study:

  • To highlight the challenges in managing stroke patients with AF during the COVID-19 pandemic.
  • To discuss the critical role of anticoagulation in cardioembolic stroke.
  • To emphasize the increased mortality risk in elderly stroke patients with COVID-19.

Main Methods:

  • Case report of an 84-year-old female with embolic stroke and non-anticoagulated AF.
  • Patient presented with severe neurological deficits (NIHSS 24) and total anterior circulation infarct (TACI).
  • Management was complicated by new embolic events, COVID-19 diagnosis, and subsequent multiorgan failure.

Main Results:

  • The patient's extensive stroke precluded anticoagulation therapy upon admission.
  • Development of new embolic events and COVID-19 infection occurred during hospitalization.
  • Progressive respiratory dysfunction and multiorgan failure led to the patient's death despite treatment.

Conclusions:

  • Anticoagulation is critical for stroke prevention in patients with AF and total infarction.
  • COVID-19 diagnosis significantly increases the mortality risk for elderly patients with stroke.
  • Timely anticoagulation assessment is vital, even in complex cases, to improve patient prognosis.
Abstract

Keywords:
COVID-19Embolismatrial fibrillationstroke

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