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Large-vessel thrombotic stroke despite concurrent therapeutic anticoagulation in COVID-19-positive patient

Andrew Shoukry1, Thomas A Kite1

  • 1Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Oxford Medical Case Reports
|December 3, 2020
PubMed

Insights

This case report details a large-vessel stroke in an anticoagulated patient with COVID-19. It highlights the risk of severe thrombotic events even with therapeutic anticoagulation during coronavirus disease 2019.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiology

Background:

  • The COVID-19 pandemic, caused by SARS-CoV-2, is linked to coagulopathy and thrombotic events.
  • Thromboembolic phenomena have been observed in critically ill COVID-19 patients.

Observation:

  • A case of a large-vessel cerebrovascular thrombus is presented in an 89-year-old male with COVID-19.
  • The patient was on therapeutic anticoagulation during his admission for COVID-19 pneumonitis.

Findings:

  • Despite clinical improvement, the patient developed an acute left-sided total anterior circulation stroke 10 days after symptom onset.
  • Computed tomography angiography revealed a large-vessel thrombus in the internal carotid artery, leading to a right middle cerebral artery territory infarction.

Implications:

  • This case represents one of the first documented instances of large-vessel thrombus in a COVID-19 patient receiving therapeutic anticoagulation.
  • It underscores the complex thrombotic risks associated with SARS-CoV-2 infection, even in anticoagulated individuals.

Keywords:
neuroimagingneurologystroke

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