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Failure of Therapeutic Anticoagulation in COVID-19 Patients With Acute Ischemic Stroke. A Retrospective Multicenter

Francesco Janes1, Gian Luigi Gigli1,2, Fedra Kuris2

  • 1Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.

Frontiers in Neurology
|March 21, 2022
PubMed

Insights

In patients with COVID-19, anticoagulation failure occurred in over 20% of acute ischemic strokes, leading to poor outcomes. This suggests COVID-19 may increase resistance to anticoagulation therapy.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiovascular Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with an increased risk of acute ischemic stroke (AIS).
  • The optimal vascular preventive strategy for COVID-19 patients remains unclear.
  • Thrombogenesis in COVID-19 stroke patients may involve unique mechanisms.

Purpose of the Study:

  • To investigate the clinical characteristics of AIS in COVID-19 patients who experienced stroke despite therapeutic anticoagulation.
  • To assess the outcomes of anticoagulated COVID-19 patients with AIS.

Main Methods:

  • Retrospective analysis of a cohort of 80 AIS patients with COVID-19 admitted to three cerebrovascular units.
  • Focus on a subgroup of 17 patients (21.2%) who were on anticoagulation therapy at the time of stroke.
  • Clinical data including stroke severity (NIHSS) and vessel occlusion were analyzed.

Main Results:

  • 17 out of 80 (21.2%) AIS patients with COVID-19 occurred despite therapeutic anticoagulation.
  • The average NIHSS score at admission was 12.0.
  • Large vessel occlusion was present in 58.8% of these patients.
  • The case fatality rate was high at 64.7%.

Conclusions:

  • Anticoagulation failure appears more frequent in COVID-19-related AIS.
  • Outcomes are worse in COVID-19 AIS patients compared to non-COVID-19 ischemic strokes.
  • COVID-19-associated thrombotic complications may be resistant to or independent of anticoagulation.
Abstract

Keywords:
COVID-19coagulopathyischemic strokelarge vessel diseasetherapeutic anticoagulation

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