Failure of Therapeutic Anticoagulation in COVID-19 Patients With Acute Ischemic Stroke. A Retrospective Multicenter Study.

Francesco Janes,Lorenzo Nesi,Roberta Giacomello,Anna Cavallini,Paolo Costa,Federico Mazzacane,Mariarosaria Valente,Fedra Kuris,Mauro Morassi,Gian Luigi Gigli,Eleonora Leuci

doi:10.3389/fneur.2022.834469

Abstract

BackgroundAcute ischemic stroke (AIS) is a possible complication of coronavirus disease 2019 (COVID-19) infection. Although peculiar clinical features and underlying specific mechanisms of thrombogenesis have been suggested so far, there is no consensus on the appropriate vascular preventive drug regimen in patients with COVID-19.Aim and MethodsFrom a larger clinical series of consecutive acute ischemic strokes related to COVID-19 admitted to three cerebrovascular units in Northern Italy, herein, we describe the clinical features of a subgroup of patients in whom stroke occurred despite therapeutic anticoagulation.ResultsA total of seventeen/80 AIS related to COVID-19 (21.2%) occurred in anticoagulated patients. Although no blood level was available for Direct Oral AntiCoagulant, the drug dosage was appropriate according to guidelines. Their National Institute of Health Stroke Scale (NIHSS) at admission was 12.0 (SD = 7.4) and 58.8% of them had evidence of large vessel occlusion. The case fatality rate was as high as 64.7%.Discussion and ConclusionsThe occurrence of an anticoagulation failure seems to be increased in the setting of COVID-19 infection, with worse clinical outcomes if compared to non-COVID-19 related ischemic strokes. We discuss the diagnostic and therapeutic implications of such evidence, suggesting that some arterial thrombotic complications might be either resistant to or independent of the anticoagulation effect.

Highlights

Acute Ischemic Stroke (AIS) has been so far reported to complicate 1–5% of coronavirus disease 2019 (COVID-19) infections [1, 2]
The baseline National Institute of Health Stroke Scale (NIHSS) was 12.0 (SD 7.4), 58.8% had an large vessel occlusion (LVO) and 41.2% were classified after diagnostic work-up as Large Artery Disease (LAD) strokes
We basically found that AISs occurring during COVID-19 infection despite therapeutical anticoagulation have clinical features different from those we already know from the literature

Summary

Introduction

Acute Ischemic Stroke (AIS) has been so far reported to complicate 1–5% of coronavirus disease 2019 (COVID-19) infections [1, 2]. Specific clinical and radiological features were described in clinical series as well as in case-control studies of COVID-19-related strokes. They include a younger age of onset, worse clinical outcome, higher proportion of large vessel occlusion, frequent multifocal involvement in the COVID-19 group, and, to some extent, a relationship with COVID-19 severity itself [3–7]. Acute ischemic stroke (AIS) is a possible complication of coronavirus disease 2019 (COVID-19) infection. Peculiar clinical features and underlying specific mechanisms of thrombogenesis have been suggested so far, there is no consensus on the appropriate vascular preventive drug regimen in patients with COVID-19

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