Hemorrhagic stroke and anticoagulation in COVID-19
Hemorrhagic stroke and anticoagulation in COVID-19
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.104984
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发表时间：
2020-08-01
影响因子：
2.5
通讯作者：
Berger, Jeffrey
中科院分区：
文献类型：
--
作者：
Dogra, Siddhant;Jain, Rajan;Berger, Jeffrey
背景和目的：2019年冠状病毒病(新冠肺炎)患者发生血栓事件和死亡的风险增加。目前正在考虑对这些患者进行各种抗凝治疗。众所周知，抗凝会增加不良出血事件的风险，其中最令人担忧的是颅内出血(ICH)。我们提出了一项对33名新冠肺炎阳性、有神经影像记录的脑出血患者的回顾性研究，并检查了该人群中抗凝药物的使用情况。方法：18岁以上的患者均经新冠肺炎确诊，并经放射学证实为脑出血。出血的证据由一位受过团契训练的神经放射科医生确认和分类。分析电子健康记录中的患者信息，包括人口统计数据、病史、医院病程、化验值和药物。结果：我们发现33例新冠肺炎阳性的脑出血患者，平均年龄61.6岁(范围37-83岁)，其中21.2%是女性。5例(15.2%)出现包块样实质出血，病死率为100%。在其余28例脑出血患者中，7例(25%)为点状出血，17例(60.7%)为中小出血，4例(14.3%)为单发大出血，无突出表现。几乎所有患者在发现脑出血前都接受了治疗性剂量的抗凝(22例(66.7%)患者)或催乳剂(3例[9.1]例)。结论：新冠肺炎患者可以考虑抗凝治疗，但在制定治疗方案时应考虑脑出血的风险。(C)2020 Elsevier Inc.保留所有权利。
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 prophy-lactic 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. (c) 2020 Elsevier Inc. All rights reserved.