目的:SARS-CoV-2(COVID)可诱发全身性血栓性并发症,包括急性缺血性卒中。在这个系列中,我们报告了炎症的标志物,凝血因子包括血管性血友病因子抗原,和旋转血栓弹性测量(ROTEM)数据。
方法:在2020年至2022年期间在单个综合卒中中心观察到的COVID患者的回顾性病例系列。对于接受机械血栓切除术(MT)的患者,在程序期间收集ROTEM数据并在ROTEMδ系统上分析。
结果:15例患者(33.3%为女性),中位年龄65岁,出现COVID和急性缺血性卒中。十三有LVO。入院时平均NIHSS为15(范围0-35),出院时平均NIHSS为18(0-42)。大多数是隐源性的(N=7,46.7%),其次是心脏栓塞(N=6,40%)和大动脉栓塞(N=2,13.3%)。8例(53%)患者出院时mRS<3。没有患者接受抗凝治疗,5人在住院前接受抗血小板治疗.七人接受了阿替普酶(tPA)溶栓治疗,10有MT。基线血小板计数为102K/uL(范围102-291K/uL)。测量了12例患者的vWF,所有高架,七个水平>400(180%)。收集6名患者的ROTEM数据。接受tPA的三名患者的EXTEM和FIBTEM数据异常(CTextem>85秒,A10EXTEM<45mm,A10FIBTEM<10mm)。值得注意的是,6名患者中有5名患者出现INTEM(CTINTEM>208sec)异常,其中两人没有接受tPA。
结论:ROTEM数据异常的vWF抗原水平升高表明COVID诱导凝血级联的变化。需要更有力的研究来调查这些发现。溶栓,MT,根据目前的临床指南,抗血小板药物应用于治疗COVID相关的缺血性卒中。
OBJECTIVE: SARS-CoV-2 (COVID) induces systemic thrombotic complications including acute ischemic stroke. In this
case series, we report markers of inflammation, coagulation factors including von Willebrand factor antigen, and rotational thromboelastometry (
ROTEM) data.
METHODS: Retrospective
case series of COVID patients seen at a single comprehensive stroke center between 2020 - 2022. For patients undergoing mechanical thrombectomy (MT), ROTEM data was collected during the procedure and analyzed on
ROTEM delta system.
RESULTS: Fifteen patients (33.3% female) median age 65-years-old presented with COVID and acute ischemic stroke. Thirteen had LVO. The mean NIHSS was 15 (range 0 - 35) on admission and 18 (0 - 42) at discharge. Most were cryptogenic (N=7, 46.7%), followed by cardioembolic (N=6, 40%) and large artery-to-artery embolization (N=2, 13.3%). mRS was < 3 in 8 (53%) patients at discharge. None of the patients were on anticoagulation, and five were on antiplatelet therapy pre-hospitalization. Seven received thrombolytics with alteplase (tPA), and 10 had MT. Baseline platelet count was 102 K/uL (range 102 - 291 K/uL). vWF was measured in 12 patients, all elevated, with seven having levels >400 (180%).
ROTEM data was collected in six patients. Three who received tPA had abnormal EXTEM and FIBTEM data (CT extem > 85secs, A10 EXTEM < 45mm, and A10 FIBTEM < 10mm). Notably, INTEM (CT INTEM >208secs) was abnormal in five of the six patients, two of whom did not receive tPA.
CONCLUSIONS: Elevated vWF antigen levels with abnormal ROTEM data suggests that COVID induces changes in the clotting cascade. More robust research is needed to investigate these findings. Thrombolytics, MT, and antiplatelet agents should be utilized to treat COVID-related ischemic stroke based on current clinical guidelines.