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Risk factors for intracerebral hemorrhage in patients with COVID-19

Kara R Melmed1,2, Meng Cao3, Siddhant Dogra4

  • 1Department of Neurology, New York University Langone Health, New York, NY, USA. kara.melmed@nyulangone.org.

Journal of Thrombosis and Thrombolysis
|September 24, 2020
PubMed

Insights

Therapeutic anticoagulation significantly increases the risk of intracerebral hemorrhage (ICH) in patients with coronavirus disease (COVID-19). This finding highlights the need for careful consideration of anticoagulation strategies in COVID-19 patients to mitigate ICH risk.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Intracerebral hemorrhage (ICH) is a severe complication of coronavirus disease (COVID-19).
  • Identifying risk factors for ICH in COVID-19 patients is crucial for management.
  • Previous studies have not fully elucidated the specific risks associated with COVID-19 and ICH.

Purpose of the Study:

  • To assess risk factors associated with intracerebral hemorrhage (ICH) in patients with COVID-19.
  • To determine the association between anticoagulation therapy and ICH in this patient population.
  • To evaluate the impact of ICH on mortality in COVID-19 patients.

Main Methods:

  • Retrospective cohort study of adult COVID-19 patients admitted between March 1 and April 27, 2020.
  • Inclusion criteria: positive COVID-19 test, primary non-traumatic intracranial hemorrhage or hemorrhagic conversion of ischemic stroke on neuroimaging.
  • Exclusion criteria: intracranial procedures, malignancy, vascular malformation. Regression models used to analyze risk factors and mortality.

Main Results:

  • Out of 416 eligible COVID-19 patients, 33 (7.9%) experienced ICH.
  • Univariate analysis showed older age, non-Caucasian race, respiratory failure requiring mechanical ventilation, and therapeutic anticoagulation were associated with ICH.
  • Adjusted regression models revealed anticoagulation use increased ICH risk five-fold (OR 5.26, p < 0.001).
  • ICH was associated with increased mortality (adjusted OR 2.6, p < 0.05).

Conclusions:

  • Therapeutic anticoagulation is a significant risk factor for intracerebral hemorrhage in COVID-19 patients.
  • Intracerebral hemorrhage is linked to increased mortality in the COVID-19 population.
  • Further research is needed to understand mechanisms and develop prevention strategies for ICH in COVID-19.

Keywords:
AnticoagulationCOVID-19Hemorrhagic strokeIntracerebral hemorrhageMechanical ventilation

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