Hemorrhagic stroke and anticoagulation in COVID-19

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.