In this paper, recently published in Neurocritical Care, the authors conducted a retrospective cohort study of patients with haemorrhagic stroke (both non-traumatic intracerebral haemorrhage and spontaneous non-aneurysmal subarachnoid haemorrhage) who were hospitalised between March 1, 2020, and May 15, 2020, within a major healthcare system in New York, during the coronavirus pandemic. Patients with haemorrhagic stroke on admission and who developed haemorrhage during hospitalisation were both included. The authors compared the clinical characteristics of patients with haemorrhagic stroke and COVID-19 to those without COVID-19 admitted to their hospital system between March 1, 2020, and May 15, 2020 (contemporary controls), and March 1, 2019, and May 15, 2019 (historical controls). During the study period in 2020, out of 4071 patients who were hospitalised with COVID-19, they identified 19 (0.5%) with haemorrhagic stroke. Of all COVID-19 with haemorrhagic stroke, only three had isolated non-aneurysmal SAH with no associated intraparenchymal haemorrhage. Among haemorrhagic stroke in patients with COVID-19, coagulopathy was the most common aetiology (73.7%); empiric anticoagulation was started in 89.5% of these patients versus 4.2% in contemporary controls (p ≤ .001) and 10.0% in historical controls (p ≤ .001). Compared to contemporary and historical controls, patients with COVID-19 had higher initial NIHSS scores, INR, PTT, and fibrinogen levels. Patients with COVID-19 also had higher rates of in-hospital mortality (84.6% vs. 4.6%, p ≤ 0.001). Sensitivity analyses excluding patients with strictly subarachnoid haemorrhage yielded similar results. The authors concluded that they observed an overall low rate of imaging-confirmed haemorrhagic stroke among patients hospitalised with COVID-19. Moreover, most haemorrhages in patients with COVID-19 infection occurred in the setting of therapeutic anticoagulation and were associated with increased mortality.
Anticoagulation use and Hemorrhagic Stroke in SARS-CoV-2 Patients Treated at a New York Healthcare System
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