A CASE REPORT OF ISCHEMIC STROKE PATIENT WITH HEMORRHAGIC TRANSFORMATION AND COVID-19 PNEUMONIA. ANTICOAGULATION THERAPY CONSIDERATION

Abstract

WHO has been declared COVID-19 outbreak as a global pandemic. Several research recommend administration of anticoagulation therapy as thrombosis prophylaxis for patients with COVID-19 infection, due to the risk of Disseminated Intravascular Coagulation (DIC), venous and arterial thromboembolism, which is life threatening. Thrombosis complications include acute pulmonary embolism, deep vein thrombosis, ischemic stroke, myocardial infarction, systemic arterial embolisms. . Ischemic stroke patients may develop a hemorrhagic transformation. Administration of anticoagulation therapy as a thrombosis prophylaxis in ischemic stroke patients with covid-19 infection is thought to increase the risk of bleeding. We report our case, female, 76 years old with sudden loss of consciousness, left facial palsy UMN type, left motoric lateralization, with premature ventricular contraction (PVC), incomplete Right Bundle Branch Block (RBBB), diabetes mellitus, hypertension stage II based on JNC VII, pneumonia COVID-19 confirmed with PCR swab. Patient received enoxaparin 0,6 ml subcutaneous injection at third day onset of stroke for 4 days. There is hemorrhagic transformation HI-1 according to ECASS classification on head ct scan evaluation at sixth day of onset. We report a case based on our experience.  There are several things must be considered before using anticoagulation therapy for COVID-19 patients, due to increased risk of bleeding, as in our reported case. This should be considered especially when we treat acute ischemic stroke patients who develop a risk of hemorrhagic transformation even without administration of anticoagulation therapy. A neurologist consideration about the risk of hemorrhagic transformation from ischemic stroke is warranted in these situation.