Khandelwal Priyank, Martínez-Pías Enrique, Bach Ivo, Prakash Tannavi, Hillen Machteld E, Martínez-Galdámez Mario, Arenillas Juan F
Department of Neurological Surgery, Rutgers New Jersey Medical School, NJ, USA.
Department of Neurology, Rutgers New Jersey Medical School, NJ, USA.
Brain Circ. 2021 May 29;7(2):135-138. doi: 10.4103/bc.bc_17_21. eCollection 2021 Apr-Jun.
Patients with COVID-19 may suffer from hemorrhagic complications. Our article highlights two cases of COVID-19-infected patients, who suffered severe epistaxis after initiation of intravenous recombinant tissue plasminogen activator (IV-rtPA) for acute ischemic stroke, followed by a sudden decline in their clinical status and ultimately leading to death within days. Given the global impact and mortality of COVID-19, it is essential to be aware of its unusual presentation and improve therapeutic strategies. We present two cases of individuals who suffered from a large vessel occlusion of and were candidates for both IV-rtPA and mechanical thrombectomy. They received IV-rtPA but had epistaxis so severe that they were not able to receive MT and died within the next few days. There are many potential mechanisms by which epistaxis can happen in an individual with COVID-19 who received IV-rtPA including invasion of the nasal mucosa and endothelium through angiotensin-converting enzyme 2 receptors by the virus. We also hypothesize that the coagulation abnormality seen in COVID-19 patients can be potentiated by the use of treatments such as IV-rtPA. We review these issues with a diagram illustrating the possible mechanisms.
新型冠状病毒肺炎（COVID-19）患者可能会出现出血性并发症。我们的文章重点介绍了两例COVID-19感染患者，他们在因急性缺血性卒中开始静脉注射重组组织型纤溶酶原激活剂（IV-rtPA）后出现严重鼻出血，随后临床状况突然恶化，最终在数天内死亡。鉴于COVID-19的全球影响和死亡率，了解其不寻常的表现并改进治疗策略至关重要。我们介绍了两例患有大血管闭塞且适合接受IV-rtPA和机械取栓治疗的患者。他们接受了IV-rtPA，但鼻出血严重，无法接受机械取栓治疗，并在接下来的几天内死亡。在接受IV-rtPA的COVID-19患者中，鼻出血可能通过多种潜在机制发生，包括病毒通过血管紧张素转换酶2受体侵入鼻黏膜和内皮。我们还推测，COVID-19患者中出现的凝血异常可能会因使用IV-rtPA等治疗方法而加剧。我们用一张图表说明了可能的机制，对这些问题进行了综述。
