Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report
<h3>Background</h3><p dir="ltr">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 (...
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2023
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| _version_ | 1864513526540795904 |
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| author | Gokhan Demir (10366814) |
| author2 | Rama Hommos (15993645) Sally Sami Al-Sirhan (15993648) Hashem Abu Serhan (15993651) Muhannad Haddadin (15993654) Umar Bin Rashid (15993657) Yamane Chawa (15993660) |
| author2_role | author author author author author author |
| author_facet | Gokhan Demir (10366814) Rama Hommos (15993645) Sally Sami Al-Sirhan (15993648) Hashem Abu Serhan (15993651) Muhannad Haddadin (15993654) Umar Bin Rashid (15993657) Yamane Chawa (15993660) |
| author_role | author |
| dc.creator.none.fl_str_mv | Gokhan Demir (10366814) Rama Hommos (15993645) Sally Sami Al-Sirhan (15993648) Hashem Abu Serhan (15993651) Muhannad Haddadin (15993654) Umar Bin Rashid (15993657) Yamane Chawa (15993660) |
| dc.date.none.fl_str_mv | 2023-05-31T03:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1186/s13256-023-03936-8 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Ischemic_stroke_in_the_setting_of_supratherapeutic_International_Normalized_Ratio_following_coronavirus_disease_2019_infection_a_case_report/25257199 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Stroke SARS-CoV-19 Ischemia Infarction INR Middle cerebral artery |
| dc.title.none.fl_str_mv | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Background</h3><p dir="ltr">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).</p><h3>Case presentation</h3><p dir="ltr">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.</p><h3>Conclusions</h3><p dir="ltr">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.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Medical Case Reports<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1186/s13256-023-03936-8" target="_blank">https://dx.doi.org/10.1186/s13256-023-03936-8</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_c48d736a3aea3abbfd71e30529af4376 |
| identifier_str_mv | 10.1186/s13256-023-03936-8 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/25257199 |
| publishDate | 2023 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case reportGokhan Demir (10366814)Rama Hommos (15993645)Sally Sami Al-Sirhan (15993648)Hashem Abu Serhan (15993651)Muhannad Haddadin (15993654)Umar Bin Rashid (15993657)Yamane Chawa (15993660)Biomedical and clinical sciencesCardiovascular medicine and haematologyStrokeSARS-CoV-19IschemiaInfarctionINRMiddle cerebral artery<h3>Background</h3><p dir="ltr">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).</p><h3>Case presentation</h3><p dir="ltr">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.</p><h3>Conclusions</h3><p dir="ltr">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.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Medical Case Reports<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1186/s13256-023-03936-8" target="_blank">https://dx.doi.org/10.1186/s13256-023-03936-8</a></p>2023-05-31T03:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1186/s13256-023-03936-8https://figshare.com/articles/journal_contribution/Ischemic_stroke_in_the_setting_of_supratherapeutic_International_Normalized_Ratio_following_coronavirus_disease_2019_infection_a_case_report/25257199CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/252571992023-05-31T03:00:00Z |
| spellingShingle | Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report Gokhan Demir (10366814) Biomedical and clinical sciences Cardiovascular medicine and haematology Stroke SARS-CoV-19 Ischemia Infarction INR Middle cerebral artery |
| status_str | publishedVersion |
| 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 | Biomedical and clinical sciences Cardiovascular medicine and haematology Stroke SARS-CoV-19 Ischemia Infarction INR Middle cerebral artery |