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 prophylactic 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.

中文翻译：

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COVID-19中的出血性中风和抗凝治疗。

背景和目的

2019年冠状病毒病（COVID-19）的患者发生血栓形成事件和死亡的风险增加。现在正在为这些患者考虑各种抗凝方案。已知抗凝会增加不良出血事件的风险，其中颅内出血（ICH）是最令人担忧的事件之一。我们目前对33例COVID-19阳性，神经影像学记录的ICH进行回顾性研究，并检查该人群的抗凝治疗情况。

方法

这项研究包括18岁以上且已确认COVID-19和ICH影像学证据的患者。出血的证据已由受过研究金的神经放射科医生确认并分类。对电子健康记录进行了分析，以获取患者信息，包括人口统计数据，病史，医院病历，实验室值和药物。

结果

我们确定了33例ICH的COVID-19阳性患者，平均年龄61.6岁（范围37-83岁），其中21.2％是女性。5例（15.2％）患者发生了具有质量效应和疝气的实质性出血，死亡率为100％。其余28例ICH患者中，有7例（25％）出现点状出血，17例（60.7％）出现中度大小的出血，4例（14.3％）出现较大的单个出血而无疝的迹象。在ICH发现之前，几乎所有患者都接受了治疗剂量的抗凝治疗（22例[66.7％]患者）或预防剂量（3例[9.1]患者）。

结论

尽管在制定治疗方案时应考虑ICH的风险，但COVID-19患者可考虑抗凝治疗。