Abstract P100: Hemorrhagic Stroke in the Setting of COVID-19 is Associated With Anticoagulation Use

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexandra Kvernland ◽  
Arooshi Kumar ◽  
Shadi Yaghi ◽  
Eytan Raz ◽  
Jennifer Frontera ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Characteristics ◽  
Hemorrhagic Stroke ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Sensitivity Analyses ◽  
Hospital System ◽  
Therapeutic Anticoagulation ◽  
Thrombotic Complications ◽  
Parametric Testing ◽  
Historical Controls

Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both non-traumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer’s exact test and non-parametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%); empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p =<0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

scholarly journals Aneurysmal subarachnoid hemorrhage and severe, catheter-induced vasospasm associated with excessive consumption of a caffeinated energy drink

2016 ◽  
Vol 22 (6) ◽  
pp. 674-678 ◽  
Author(s):  
Ryan A Grant ◽  
Branden J Cord ◽  
Lovemore Kuzomunhu ◽  
Kevin Sheth ◽  
Emily Gilmore ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cardiac Death ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Energy Drink ◽  
Anterior Communicating Artery ◽  
Over The Counter ◽  
Vasoactive Substances ◽  
Energy Drink Consumption ◽  
Thrombotic Complications ◽  
Excessive Consumption

Excessive consumption of over-the-counter stimulants is associated with coronary vasospasm, thrombotic complications, and sudden cardiac death. Their effects on cerebrovascular physiology are not yet described in the neurointerventional literature. Patients are increasingly exposed to high levels of these vasoactive substances in the form of caffeinated energy drinks and specialty coffees. We report a case of aneurysmal subarachnoid hemorrhage (SAH) and severe, catheter-induced vasospasm during attempted endovascular repair of a ruptured anterior communicating artery (AComA) aneurysm in the setting of excessive energy drink consumption. We review the literature and alert clinicians to this potentially serious complication.

scholarly journals Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Tao Liu ◽  
Huiru Ding ◽  
Renmin Xue
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Adverse Events ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Heterogeneous Data ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract BackgroundTranexamic acid, as a hemostatic drug, is widely used to treat or prevent excessive blood loss. The efficacy of tranexamic acid in promoting good clinical outcomes, reducing mortality, and the occurrence of adverse events during treatment of aneurysmal subarachnoid hemorrhage remains unclear.MethodsPubMed, Web of Science, Embase, and The Cochrane Library were searched for randomized-controlled trials (from1980 to 2021) following strict inclusion and exclusion criteria. We performed STATA 16.0 and RevMan 5.3 for statistical analysis. Fixed-effect model (M-H method) and effect size RR (95% CI) were used as a pooled measure to combine the heterogeneous data. We also performed post hoc sensitivity analyses and conducted subgroup analyses to evaluate each outcome with low heterogeneity results.ResultsMeta-analysis showed that tranexamic acid was associated with reduced rebleeding(RR 0.72 [0.59, 0.87], p= 0.0008; I2:0%, p = 0.51). Tranexamic acid probably has no effect on good clinical outcome or mortality (RR 0.98 [0.92,1.04], p = 0.51; I2: 0%, p = 0.60; RR 1.01 [0.88,1.15], p=0.91; I2:0%, p = 0.51).TXA was associated with increased hydrocephalus (RR 1.13 [1.02, 1.24], p = 0.02; I2:0%, p = 0.61), DCI (RR 1.70 [1.34, 2.16], p < 0.0001; I2: 0%, p= 0.84) and seizure (RR 1.46 [1.00, 2.14], p= 0.05),The rate for thromboembolic complications were similar in both groups(RR 0.91 [0.63, 1.31], p = 0.62;I2: 0%, p = 0.73). There was significant drug related overall adverse events (RR 1.21 [1.11, 1.32], p < 0.0001; I2: 29%, p = 0.14).ConclusionsIn patients with aneurysmal subarachnoid hemorrhage, these findings indicate that it does not support the routine use of TXA.

Clinical characteristics and outcomes of neurogenic stress cadiomyopathy in aneurysmal subarachnoid hemorrhage

2013 ◽  
Vol 115 (7) ◽  
pp. 909-914 ◽  
Author(s):  
Kent J. Kilbourn ◽  
Stephanie Levy ◽  
Ilene Staff ◽  
Inam Kureshi ◽  
Louise McCullough
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Characteristics ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurogenic Stress

scholarly journals Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage

2011 ◽  
Vol 31 (7) ◽  
pp. 1545-1553 ◽  
Author(s):  
Mervyn DI Vergouwen ◽  
Nima Etminan ◽  
Don Ilodigwe ◽  
R Loch Macdonald
Keyword(s):  
Clinical Trials ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Functional Outcome ◽  
Observational Studies ◽  
Outcome Measure ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Sensitivity Analyses ◽  
Double Blind

Despite an undisputed association between vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (SAH), there is debate if this association implies causality. It has been suggested that cerebral infarction is a better outcome measure than vasospasm in clinical trials and observational studies. To further investigate the relationship between infarction and outcome, we performed a systematic review and meta-analysis of all randomized, double-blind, placebo-controlled trials that studied the efficacy of pharmaceutical preventive strategies in SAH patients, and had both cerebral infarction and clinical outcome as outcome events. Effect sizes were expressed in (pooled) risk ratio (RR) estimates with corresponding 95% confidence intervals (CIs). Sensitivity analyses were performed for studies with a low risk of bias and for those who reported outcome at 3 months after SAH. Twenty-four studies including 8,552 patients were included. Pharmaceutical treatments decreased the incidence of both cerebral infarction (RR: 0.83; 95% CI: 0.74 to 0.93) and of poor functional outcome (RR: 0.92; 95% CI: 0.86 to 0.98). The sensitivity analyses did not change the results essentially. These data suggest that the previously observed association between cerebral infarction and functional outcome implies causality, and that cerebral infarction is a better outcome measure than vasospasm in clinical trials and observational studies.

scholarly journals Early Identification of Individuals at High Risk for Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage: The BEHAVIOR Score

2015 ◽  
Vol 35 (10) ◽  
pp. 1587-1592 ◽  
Author(s):  
Ramazan Jabbarli ◽  
Matthias Reinhard ◽  
Roland Roelz ◽  
Mukesch Shah ◽  
Wolf-Dirk Niesen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Cerebral Infarction ◽  
Risk Score ◽  
Clinical Characteristics ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Absolute Risk ◽  
Poor Clinical Outcome ◽  
Fisher Grade ◽  
Intracranial Pressure Elevation

Cerebral infarction (CI) is a crucial complication of aneurysmal subarachnoid hemorrhage (SAH) associated with poor clinical outcome. We aimed at developing an early risk score for CI based on clinical characteristics available at the onset of SAH. Out of a database containing 632 consecutive patients with SAH admitted to our institution from January 2005 to December 2012, computed tomography (CT) scans up to day 42 after ictus were evaluated for CIs. Different parameters from admission up to aneurysm treatment were collected with subsequent construction of a risk score. Seven clinical characteristics were independently associated with CI and included in the Risk score (BEHAVIOR Score, 0 to 11 points): Blood on CT scan according to Fisher grade ≥ 3 (1 point), Elderly patients (age ≥ 55 years, 1 point), Hunt&Hess grade ≥ 4 (1 point), Acute hydrocephalus requiring external liquor drainage (1 point), Vasospasm on initial angiogram (3 points), Intracranial pressure elevation > 20 mm Hg (3 points), and treatment of multiple aneurysms (‘Overtreatment’, 1 point). The BEHAVIOR score showed high diagnostic accuracy with respect to the absolute risk for CI (area under curve = 0.806, P < 0.0001) and prediction of poor clinical outcome at discharge ( P < 0.0001) and after 6 months ( P = 0.0002). Further validation in other SAH cohorts is recommended.

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