PDF(Pubmed)
Abstract：
BACKGROUND: SARS-CoV-19 infection is associated with an increased risk of thrombotic events. We present a case of acute middle cerebral artery ischemic stroke in a patient with SARS-CoV-19 infection despite being on warfarin with supratherapeutic INR (International Normalized Ratio).
METHODS: A 68-year-old Caucasian female with multiple comorbidities was admitted to the hospital with symptoms of upper respiratory tract infection. A rapid antigen test confirmed the diagnosis of COVID-19 pneumonia, and intravenous remdesivir was initiated. On the fifth day of admission, the patient experienced sudden onset confusion, slurred speech, left-sided hemiplegia, right-sided eye deviation, and left-sided facial droop. Imaging studies revealed an occlusion of the distal anterior M2 segment of the right middle cerebral artery, and an MRI of the brain confirmed an acute right MCA infarction. Notably, the patient was receiving warfarin therapy with a supratherapeutic INR of 3.2.
CONCLUSIONS: This case report highlights the potential for thromboembolic events, including stroke, in patients with COVID-19 infection, even when receiving therapeutic anticoagulation therapy. Healthcare providers should be vigilant for signs of thrombosis in COVID-19 patients, particularly those with pre-existing risk factors. Further research is necessary to understand the pathophysiology and optimal management of thrombotic complications in COVID-19 patients.
METHODS: A 68-year-old Caucasian female with multiple comorbidities was admitted to the hospital with symptoms of upper respiratory tract infection. A rapid antigen test confirmed the diagnosis of COVID-19 pneumonia, and intravenous remdesivir was initiated. On the fifth day of admission, the patient experienced sudden onset confusion, slurred speech, left-sided hemiplegia, right-sided eye deviation, and left-sided facial droop. Imaging studies revealed an occlusion of the distal anterior M2 segment of the right middle cerebral artery, and an MRI of the brain confirmed an acute right MCA infarction. Notably, the patient was receiving warfarin therapy with a supratherapeutic INR of 3.2.
CONCLUSIONS: This case report highlights the potential for thromboembolic events, including stroke, in patients with COVID-19 infection, even when receiving therapeutic anticoagulation therapy. Healthcare providers should be vigilant for signs of thrombosis in COVID-19 patients, particularly those with pre-existing risk factors. Further research is necessary to understand the pathophysiology and optimal management of thrombotic complications in COVID-19 patients.
摘要：
背景：SARS-CoV-19感染与血栓事件风险增加相关。我们介绍了一例SARS-CoV-19感染患者的急性大脑中动脉缺血性中风的病例，尽管正在服用华法林并治疗性INR（国际标准化比率）。
方法：一名68岁的高加索女性合并多种疾病，因上呼吸道感染症状入院。快速抗原检测证实了COVID-19肺炎的诊断，并开始静脉注射雷米西韦。在入学的第五天，患者突然出现意识模糊，含糊不清的讲话，左侧偏瘫,右侧眼睛偏离,左侧面部下垂。影像学检查显示右大脑中动脉远端前M2段闭塞,脑部MRI证实右MCA急性梗死.值得注意的是,患者接受华法林治疗,超治疗INR为3.2.
结论：本病例报告强调了血栓栓塞事件的可能性，包括中风,在COVID-19感染患者中，即使接受治疗性抗凝治疗。医疗保健提供者应警惕COVID-19患者的血栓形成迹象，特别是那些预先存在风险因素的人。需要进一步研究以了解COVID-19患者血栓性并发症的病理生理学和最佳管理。
方法：一名68岁的高加索女性合并多种疾病，因上呼吸道感染症状入院。快速抗原检测证实了COVID-19肺炎的诊断，并开始静脉注射雷米西韦。在入学的第五天，患者突然出现意识模糊，含糊不清的讲话，左侧偏瘫,右侧眼睛偏离,左侧面部下垂。影像学检查显示右大脑中动脉远端前M2段闭塞,脑部MRI证实右MCA急性梗死.值得注意的是,患者接受华法林治疗,超治疗INR为3.2.
结论：本病例报告强调了血栓栓塞事件的可能性，包括中风,在COVID-19感染患者中，即使接受治疗性抗凝治疗。医疗保健提供者应警惕COVID-19患者的血栓形成迹象，特别是那些预先存在风险因素的人。需要进一步研究以了解COVID-19患者血栓性并发症的病理生理学和最佳管理。
