Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report

Journal of Medical Case Reports

Case Report

Rama Hommos¹  Sally Sami Al-Sirhan¹  Muhannad Haddadin²  Gokhan Demir²  Umar Bin Rashid²  Yamane Chawa²  Hashem Abu Serhan³ 

[1] College of Medicine, Qatar University, Doha, Qatar;Department of Internal Medicine, Hamad General Hospital, Doha, Qatar;Department of Ophthalmology, Hamad General Hospital, Doha, Qatar;

关键词: Stroke;    SARS-CoV-19;    Ischemia;    Infarction;    INR;    Middle cerebral artery;   

DOI  :  10.1186/s13256-023-03936-8

 received in 2022-12-13, accepted in 2023-04-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSARS-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).Case presentationA 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.ConclusionsThis 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.

【 授权许可】

CC BY   
© The Author(s) 2023

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