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Hemorrhagic stroke and anticoagulation in COVID-19
Siddhant Dogra1, Rajan Jain2, Meng Cao3
1Department of Radiology, New York University Langone Health, New York, NY, United States.
Insights
Patients with Coronavirus Disease 2019 (COVID-19) face higher risks of blood clots and death. This study examined intracranial hemorrhage (ICH) in 33 COVID-19 patients, finding most received anticoagulation before their bleeding event.
Area of Science:
- Neurology
- Hematology
- Infectious Diseases
Background:
- Patients with Coronavirus Disease 2019 (COVID-19) exhibit an elevated risk of thrombotic events and mortality.
- Anticoagulation therapy, while crucial for managing thrombosis, inherently increases the risk of bleeding complications, including intracranial hemorrhage (ICH).
Purpose of the Study:
- To investigate the incidence and characteristics of neuroimaging-documented intracranial hemorrhage (ICH) in patients with COVID-19.
- To examine the patterns of anticoagulation use in COVID-19 patients who developed ICH.
Main Methods:
- Retrospective analysis of 33 patients diagnosed with COVID-19 and confirmed intracranial hemorrhage (ICH) via neuroimaging.
- Detailed review of electronic health records for demographic data, medical history, hospital course, laboratory values, and medication use, including anticoagulation.
- Neuroradiologist confirmation and categorization of hemorrhage type and severity.
Main Results:
- The study identified 33 COVID-19 positive patients with ICH, with a mean age of 61.6 years.
- Five patients (15.2%) experienced parenchymal hemorrhages with mass effect and herniation, all resulting in mortality.
- The majority of patients (nearly all) received therapeutic or prophylactic anticoagulation prior to the discovery of ICH.
Conclusions:
- Anticoagulation is frequently utilized in COVID-19 patients.
- The risk of intracranial hemorrhage (ICH) must be carefully considered when prescribing anticoagulation therapy for COVID-19 patients.
- Treatment regimens for COVID-19 patients require a balanced approach, weighing the benefits of anticoagulation against the potential risk of bleeding events like ICH.
Background And Purpose:
Patients with the Coronavirus Disease of 2019 (COVID-19) are at increased risk for thrombotic events and mortality. Various anticoagulation regimens are now being considered for these patients. Anticoagulation is known to increase the risk for adverse bleeding events, of which intracranial hemorrhage (ICH) is one of the most feared. We present a retrospective study of 33 patients positive for COVID-19 with neuroimaging-documented ICH and examine anticoagulation use in this population.
Methods:
Patients over the age of 18 with confirmed COVID-19 and radiographic evidence of ICH were included in this study. Evidence of hemorrhage was confirmed and categorized by a fellowship trained neuroradiologist. Electronic health records were analyzed for patient information including demographic data, medical history, hospital course, laboratory values, and medications.
Results:
We identified 33 COVID-19 positive patients with ICH, mean age 61.6 years (range 37-83 years), 21.2% of whom were female. Parenchymal hemorrhages with mass effect and herniation occurred in 5 (15.2%) patients, with a 100% mortality rate. Of the remaining 28 patients with ICH, 7 (25%) had punctate hemorrhages, 17 (60.7%) had small- moderate size hemorrhages, and 4 (14.3%) had a large single site of hemorrhage without evidence of herniation. Almost all patients received either therapeutic dose anticoagulation (in 22 [66.7%] patients) or prophylactic dose (in 3 [9.1] patients) prior to ICH discovery.
Conclusions:
Anticoagulation therapy may be considered in patients with COVID-19 though the risk of ICH should be taken into account when developing a treatment regimen.
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