Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report
Abstract Background SARS-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 pr...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-03936-8 |
| _version_ | 1797811484181397504 |
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| author | Gokhan Demir Rama Hommos Sally Sami Al-Sirhan Hashem Abu Serhan Muhannad Haddadin Umar Bin Rashid Yamane Chawa |
| author_facet | Gokhan Demir Rama Hommos Sally Sami Al-Sirhan Hashem Abu Serhan Muhannad Haddadin Umar Bin Rashid Yamane Chawa |
| author_sort | Gokhan Demir |
| collection | DOAJ |
| description | Abstract Background SARS-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 presentation A 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. Conclusions This 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. |
| first_indexed | 2024-03-13T07:24:15Z |
| format | Article |
| id | doaj.art-5aefb2c5b65e4041b866173cd2a8c3a0 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-13T07:24:15Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-5aefb2c5b65e4041b866173cd2a8c3a02023-06-04T11:29:46ZengBMCJournal of Medical Case Reports1752-19472023-05-011711510.1186/s13256-023-03936-8Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case reportGokhan Demir0Rama Hommos1Sally Sami Al-Sirhan2Hashem Abu Serhan3Muhannad Haddadin4Umar Bin Rashid5Yamane Chawa6Department of Internal Medicine, Hamad General HospitalCollege of Medicine, Qatar UniversityCollege of Medicine, Qatar UniversityDepartment of Ophthalmology, Hamad General HospitalDepartment of Internal Medicine, Hamad General HospitalDepartment of Internal Medicine, Hamad General HospitalDepartment of Internal Medicine, Hamad General HospitalAbstract Background SARS-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 presentation A 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. Conclusions This 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.https://doi.org/10.1186/s13256-023-03936-8StrokeSARS-CoV-19IschemiaInfarctionINRMiddle cerebral artery |
| spellingShingle | Gokhan Demir Rama Hommos Sally Sami Al-Sirhan Hashem Abu Serhan Muhannad Haddadin Umar Bin Rashid Yamane Chawa Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report Journal of Medical Case Reports Stroke SARS-CoV-19 Ischemia Infarction INR Middle cerebral artery |
| title | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report |
| title_full | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report |
| title_fullStr | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report |
| title_full_unstemmed | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report |
| title_short | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report |
| title_sort | ischemic stroke in the setting of supratherapeutic international normalized ratio following coronavirus disease 2019 infection a case report |
| topic | Stroke SARS-CoV-19 Ischemia Infarction INR Middle cerebral artery |
| url | https://doi.org/10.1186/s13256-023-03936-8 |
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