tetano
Editor, Senior Moderator
Neurohospitalist
. 2021 Apr;11(2):131-136.
doi: 10.1177/1941874420960324. Epub 2020 Sep 23.
COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke
Naresh Mullaguri[SUP] 1 [/SUP], Madihah Hepburn[SUP] 1 [/SUP], James Matthew Gebel Jr[SUP] 1 2 [/SUP], Ahmed Itrat[SUP] 1 2 [/SUP], Pravin George[SUP] 1 [/SUP], Christopher R Newey[SUP] 1 3 [/SUP]
Affiliations
Abstract
Introduction: SARS-Coronavirus-2 infection leading to COVID-19 disease presents most often with respiratory failure. The systemic inflammatory response of SARS-CoV-2 along with the hypercoagulable state that the infection elicits can lead to acute thrombotic complications including ischemic stroke. We present 3 cases of patients with COVID-19 disease who presented with varying degrees of vascular thrombosis.
Cases: Cases 1 and 2 presented as cerebral ischemic strokes without respiratory failure. Given their exposure risks, they were both tested for COVID-19 disease. Case 2 ultimately developed respiratory failure and pulmonary embolism. Cases 2 and 3 were found to have simultaneous arterial and venous thromboembolism (ischemic stroke and pulmonary embolism) as well as positive antiphospholipid antibodies.
Conclusion: Our case series highlight the presence of hypercoagulability as an important mechanism in patients with COVID-19 disease with and without respiratory failure. Despite arterial and venous thromboembolic events, antiphospholipid and hypercoagulable panels in the acute phase can be difficult to interpret in the context of acute phase response and utilization of thrombolytics. SARS-CoV-2 testing in patients presenting with stroke symptoms may be useful in communities with a high case burden or patients with a history of exposure.
Keywords: COVID-19; hypercoagulability; ischemic stroke; respiratory failure.
. 2021 Apr;11(2):131-136.
doi: 10.1177/1941874420960324. Epub 2020 Sep 23.
COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke
Naresh Mullaguri[SUP] 1 [/SUP], Madihah Hepburn[SUP] 1 [/SUP], James Matthew Gebel Jr[SUP] 1 2 [/SUP], Ahmed Itrat[SUP] 1 2 [/SUP], Pravin George[SUP] 1 [/SUP], Christopher R Newey[SUP] 1 3 [/SUP]
Affiliations
- PMID: 33791056
- PMCID: PMC7958691 (available on 2022-04-01)
- DOI: 10.1177/1941874420960324
Abstract
Introduction: SARS-Coronavirus-2 infection leading to COVID-19 disease presents most often with respiratory failure. The systemic inflammatory response of SARS-CoV-2 along with the hypercoagulable state that the infection elicits can lead to acute thrombotic complications including ischemic stroke. We present 3 cases of patients with COVID-19 disease who presented with varying degrees of vascular thrombosis.
Cases: Cases 1 and 2 presented as cerebral ischemic strokes without respiratory failure. Given their exposure risks, they were both tested for COVID-19 disease. Case 2 ultimately developed respiratory failure and pulmonary embolism. Cases 2 and 3 were found to have simultaneous arterial and venous thromboembolism (ischemic stroke and pulmonary embolism) as well as positive antiphospholipid antibodies.
Conclusion: Our case series highlight the presence of hypercoagulability as an important mechanism in patients with COVID-19 disease with and without respiratory failure. Despite arterial and venous thromboembolic events, antiphospholipid and hypercoagulable panels in the acute phase can be difficult to interpret in the context of acute phase response and utilization of thrombolytics. SARS-CoV-2 testing in patients presenting with stroke symptoms may be useful in communities with a high case burden or patients with a history of exposure.
Keywords: COVID-19; hypercoagulability; ischemic stroke; respiratory failure.