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Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study

  • Lang, Corinna N.1, 2
  • Dettinger, Johanna S.1, 2
  • Berchtold-Herz, Michael1
  • Utzolino, Stefan2
  • Bemtgen, Xavier1, 2
  • Zotzmann, Viviane1, 2
  • Schmid, Bonaventura2
  • Biever, Paul M.1, 2
  • Bode, Christoph1, 2
  • Müller-Peltzer, Katharina2
  • Duerschmied, Daniel1, 2
  • Wengenmayer, Tobias1, 2
  • Niesen, Wolf-Dirk2
  • Staudacher, Dawid L.1, 2
  • 1 Heart Center Freiburg University, University of Freiburg,
  • 2 University of Freiburg,
Published Article
Neurocritical Care
Springer US
Publication Date
Feb 23, 2021
DOI: 10.1007/s12028-021-01202-7
PMID: 33619668
PMCID: PMC7899797
PubMed Central


Background Hypercoagulability in Coronavirus Disease 2019 (COVID-19) causes deep vein thrombosis and pulmonary embolism necessitating systemic anticoagulation. Case reports of intracerebral hemorrhages in ventilated COVID-19 patients warrant precaution. It is unclear, however, if COVID-19 patients with acute respiratory distress syndrome (ARDS) with or without veno-venous extracorporeal membrane oxygenation therapy (VV-ECMO) have more intracerebral hemorrhages (ICH) compared to other ARDS patients. Methods We conducted a retrospective observational single-center study enrolling all patients with ARDS from 01/2018 to 05/2020. PCR-positive SARS-CoV-2 patients with ARDS were allocated to the COVID-19 group. Propensity score matching was performed for age, VV-ECMO, and bleeding risk. Results A total of 163 patients with moderate or severe ARDS were identified, 47 (28.8%) in the COVID-19 group, and 116 (71.2%) in the non-COVID-19 group. In 63/163 cases (38.7%), VV-ECMO therapy was required. The ICU survival was 52.8%. COVID-19 patients were older, more often male, and exhibited a lower SOFA score, but the groups showed similar rates of VV-ECMO therapy. Treatments with antiplatelet agents ( p = 0.043) and therapeutic anticoagulation ( p = 0.028) were significantly more frequent in the COVID-19 patients. ICH was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.57), thus leveling out possible confounders. Conclusions Intracerebral hemorrhage was detected in every tenth patient with ARDS. Despite statistically higher rates of antiplatelet therapy and therapeutic anticoagulation in COVID-19 patients, we found a similar rate of ICH in patients with ARDS due to COVID-19 compared to other causes of ARDS. Supplementary Information The online version contains supplementary material available at (doi:10.1007/s12028-021-01202-7).

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