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Risk factors for intracerebral hemorrhage in patients with COVID-19.

Authors
  • Melmed, Kara R1, 2
  • Cao, Meng3
  • Dogra, Siddhant4
  • Zhang, Ruina3
  • Yaghi, Shadi5
  • Lewis, Ariane5, 6
  • Jain, Rajan6, 4
  • Bilaloglu, Seda7
  • Chen, Ji7
  • Czeisler, Barry M5, 6
  • Raz, Eytan4
  • Lord, Aaron5
  • Berger, Jeffrey S8
  • Frontera, Jennifer A5
  • 1 Department of Neurology, New York University Langone Health, New York, NY, USA. [email protected]
  • 2 Department of Neurosurgery, New York University Langone Health, New York, NY, USA. [email protected]
  • 3 Department of Medicine, New York University Langone Health, New York, NY, USA.
  • 4 Department of Radiology, New York University Langone Health, New York, NY, USA.
  • 5 Department of Neurology, New York University Langone Health, New York, NY, USA.
  • 6 Department of Neurosurgery, New York University Langone Health, New York, NY, USA.
  • 7 Department of Population Health, New York University Langone Health, New York, NY, USA.
  • 8 Department of Cardiology, New York University Langone Health, New York, NY, USA.
Type
Published Article
Journal
Journal of Thrombosis and Thrombolysis
Publisher
Springer-Verlag
Publication Date
May 01, 2021
Volume
51
Issue
4
Pages
953–960
Identifiers
DOI: 10.1007/s11239-020-02288-0
PMID: 32968850
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Intracerebral hemorrhage (ICH) can be a devastating complication of coronavirus disease (COVID-19). We aimed to assess risk factors associated with ICH in this population. We performed a retrospective cohort study of adult patients admitted to NYU Langone Health system between March 1 and April 27 2020 with a positive nasopharyngeal swab polymerase chain reaction test result and presence of primary nontraumatic intracranial hemorrhage or hemorrhagic conversion of ischemic stroke on neuroimaging. Patients with intracranial procedures, malignancy, or vascular malformation were excluded. We used regression models to estimate odds ratios and 95% confidence intervals (OR, 95% CI) of the association between ICH and covariates. We also used regression models to determine association between ICH and mortality. Among 3824 patients admitted with COVID-19, 755 patients had neuroimaging and 416 patients were identified after exclusion criteria were applied. The mean (standard deviation) age was 69.3 (16.2), 35.8% were women, and 34.9% were on therapeutic anticoagulation. ICH occurred in 33 (7.9%) patients. Older age, non-Caucasian race, respiratory failure requiring mechanical ventilation, and therapeutic anticoagulation were associated with ICH on univariate analysis (p < 0.01 for each variable). In adjusted regression models, anticoagulation use was associated with a five-fold increased risk of ICH (OR 5.26, 95% CI 2.33-12.24, p < 0.001). ICH was associated with increased mortality (adjusted OR 2.6, 95 % CI 1.2-5.9). Anticoagulation use is associated with increased risk of ICH in patients with COVID-19. Further investigation is required to elucidate underlying mechanisms and prevention strategies in this population.

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