Department of Radiology, New York University Langone Health, New York, NY, United States.
Department of Radiology, New York University Langone Health, New York, NY, United States; Department of Neurosurgery, New York University Langone Health, New York, NY, United States.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104984. doi: 10.1016/j.jstrokecerebrovasdis.2020.104984. Epub 2020 May 23.
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.
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.
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 prophylactic dose (in 3 [9.1] patients) prior to ICH discovery.
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.
患有 2019 年冠状病毒病（COVID-19）的患者发生血栓事件和死亡的风险增加。目前正在考虑为这些患者使用各种抗凝方案。已知抗凝会增加不良出血事件的风险，其中颅内出血（ICH）是最令人恐惧的事件之一。我们报告了 33 例经神经影像学证实为 COVID-19 合并 ICH 的患者的回顾性研究，并检查了该人群中抗凝的使用情况。
本研究纳入了年龄在 18 岁以上、确诊 COVID-19 且影像学有 ICH 证据的患者。由一名经过 fellowship培训的神经放射科医生对出血证据进行确认和分类。分析电子病历以获取患者信息，包括人口统计学数据、病史、住院过程、实验室值和药物。
我们共确定了 33 例 COVID-19 阳性合并 ICH 的患者，平均年龄为 61.6 岁（范围为 37-83 岁），其中 21.2%为女性。5 例（15.2%）患者发生有占位效应和脑疝的实质内出血，死亡率为 100%。在其余 28 例 ICH 患者中，7 例（25%）有局灶性出血，17 例（60.7%）有小-中型出血，4 例（14.3%）有单一部位的大血肿，但无证据表明有脑疝。几乎所有患者在发现 ICH 之前都接受了治疗剂量抗凝（22 例，66.7%）或预防剂量抗凝（3 例，9.1%）。
尽管在制定治疗方案时应考虑 ICH 的风险，但对于 COVID-19 患者可以考虑抗凝治疗。
