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Keywords	Anesthesiology and Pain Medicine ; Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2020.09.081
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Article: Intracranial haemorrhage associated with systemic anticoagulation in ventilated COVID-19 Intensive care patients

Lenartova, K. / Palomo-Lopez, N. / Hoy, M. / Kviatkovske, O. / Walker, C.

Journal of Cardiothoracic and Vascular Anesthesia

Abstract: ... used 2,3 Methods: Review of COVID-19 positive adult patients admitted to the critical care unit between ... seen in critically ill COVID-19 patients 2,3 have led to such patients being treated empirically ... intracranial haemorrhage and subsequently died Discussion: The risk for any significant haemorrhage in patients ...

Abstract	Introduction: COVID-19 induces a pro-inflammatory, hypercoagulable state with marked elevations of ferritin, C-reactive protein, interleukin, and D-dimers Observed consequences include pro-thrombotic disseminated intravascular coagulation (DIC) with a high rate of venous thromboembolism (VTE) and elevated D-dimers with high fibrinogen and low anti-thrombin levels Pulmonary congestion appears to be due to micro-vascular thrombosis and occlusion on pathological examination 1 The acquired pro-thrombotic state and associated poorer outcomes seen in critically ill COVID-19 patients 2,3 have led to such patients being treated empirically with systemic anticoagulants Unfractionated heparin (UFH) or low molecular weight heparin (LMWH) have both been used 2,3 Methods: Review of COVID-19 positive adult patients admitted to the critical care unit between 10th March and 13th May 2020 with severe respiratory failure requiring invasive ventilation Results: In that period we admitted 59 patients 6 (10%) females, 56 (90%) males 45 (76%) patients required therapeutic anticoagulation (27 UFH, 14 LMWH, 4 argatroban) 4 (8 9%) of the 45 anticoagulated patients suffered catastrophic intracranial haemorrhage and subsequently died Discussion: The risk for any significant haemorrhage in patients systemically anticoagulated for VTE with unfractionated heparin (UFH) is 2-3%, 4 and that of anticoagulant-related intracranial haemorrhage (AICH) in patients systemically anticoagulated with UFH is 1-2 7% (in patients treated for ischaemic stroke) and 4% with argatroban 5 We report a much higher incidence of nearly 9% The cases we present fulfilled the advised criteria for systemic anticoagulation Despite four-hourly monitoring of APPT and anti-Xa activity on the intensive care unit there were significant fluxes in these laboratory markers of anticoagulation These may be associated with the uncharted nature of this disease process It is impossible to disassociate the necessary therapeutic-intensity anticoagulation with the observed heightened frequency of life-ending intracranial haemorrhage in these patients
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #900025
Database	COVID19

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