Intracranial Hemorrhage Associated with Therapeutic Anticoagulation in Three Critically Ill COVID-19 Patients: A Case Series

Introduction: The COVID-19 pandemic has challenged global health with novel pathogenesis that is both severe and poorly understood. Several mechanisms have been proposed to explain the severity and complexity of the clinical illness including cytokine storm release, thromboembolic microangiopathy, direct cytotoxicity, and post-viral bacterial super infection. Cases: The patients in this case series were all admitted to the intensive care unit with respiratory failure from COVID-19 requiring invasive mechanical ventilation. They were all started on anticoagulation. All three patients developed acute kidney injuries. The first patient had hypertensive emergency at the time of the bleed. The second and third patient both had supratherapeutic heparin levels at the time of the bleed. Methods: We followed patients aged 18 years and above who were admitted to the ICU for COVID-19 during April and May 2020. We then followed those who required therapeutic anticoagulation for any indication and evaluated the ones that developed ICH. Results: Out of the 79 patients admitted to the ICU for COVID-19 related illness during April and May 2020, 31 were placed on therapeutic anticoagulation (intermediate or full-dose) for indications that included hypercoagulable state, ACS, atrial fibrillation, and deep vein thrombosis. 25% of patients on anticoagulation developed bleeding for which the anticoagulation had to be stopped. Three out of these 31 patients developed ICH while on anticoagulation, accounting for 3.8% of our ICU population with COVID-19 Discussion: Activation of coagulation pathways during cytokine storms can result in systemic thromboembolism, in both venous and arterial circulations posing risk of ischemic infarctions to any organ. Supratherapeutic heparin levels and acute kidney injuries are common in COVID-19 patients. The ideal candidates for anticoagulation, the recommended agent and dose, and duration of treatment remain unclear. Conclusion: The benefits of anticoagulation should be weighed against the potential risk of bleeding.

The Vein Of Galen Aneurysmal Malformation Associated With Sinus Venosus Defect And Anomalous Pulmonary Veins

he Vein of Galen Aneurysmal Malformation (VGAM) is a rare cerebral arteriovenous shunt, which may be associated with a congenital cardiac defect. Embolisation of the VGAM is safer in infancy, even it may be undertaken in the neonatal period if necessary.

Persistent Sciatic Artery Presenting With Right Lower Limb Ischemia: A Potential Sonographic Pitfall

A case of persistent sciatic artery is reported in a patient with the lower limb ischaemia. Initial imaging dopplar sonography suggested a possible occlusion of the superficial femoral artery.

Coronavirus Disease 2019 And Cardiovascular Disease: Does This Novel Disease Directly Affect The Cardiovascular System?

The coronavirus disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The worsening of COVID-19 is caused by viral pneumonia, but the disease also remarkably affects the cardiovascular system.

Prolonged QTc Interval In Stress-Induced Takotsubo Cardiomyopathy

Takotsubo Cardiomyopathy is a non-ischemic cardiomyopathy characterized by reversible apical ballooning of the left ventricle presenting with a clinical syndrome mimicking acute coronary syndrome in the absence of significant coronary disease.

Evaluation Of Public Awareness, Knowledge And Attitudes Towards Basic Life Support Among Non-Medical, Adult Population In Muscat City, Oman: Cross-Sectional Study

Life-threatening illnesses or injuries may occur at places where there are no health service providers, so it is imperative that laypeople are equipped with all necessary knowledge and skills to provide BLS.