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Anticoagulant therapy for stroke prevention in patients with severe COVID-19

https://doi.org/10.14412/2074-2711-2021-5-20-25

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Abstract

During the pandemic of the new coronavirus infection, there is increasing evidence of neurological complications associated with COVID-19. There is no doubt that stroke can be a major complication in patients with severe disease course.

Objective: to determine the safest and most effective anticoagulant for stroke prevention in patients with severe COVID-19.

Patients and methods. A prospective study enrolled 520 patients with severe COVID-19. We used the following criteria for severe COVID-19: SpO2 <92% on room air at sea level, PaO2 /FiO2 <300 mm Hg, respiratory rate >30 breaths/min, lung infiltrates >50% on computed tomography. The study included 509 patients, divided into three groups depending on the type of anticoagulant therapy: patients of the 1st group received 24–36 thousand IU of heparin, patients of the 2nd group – enoxaparin at a dose of 1 mg/kg per day, patients of the 3rd group – rivaroxaban at a dose of 20 mg/day. The duration of anticoagulant administration depended on the severity of the patient's condition, dynamics of laboratory parameters (D-dimer, fibrinogen, international normalized ratio, activated partial thromboplastin time, platelet count), and varied from 2 to 6 weeks. In addition, we studied the incidence of ischemic and hemorrhagic strokes and transient ischemic attacks during a 6-week follow-up period. The article also presents a clinical case of large artery thrombosis in a young patient with severe COVID-19 without stroke risk factors.

Results and discussion. Even against the background of active primary prevention, stroke incidence was 2.6% (0.6% for ischemic stroke, 1.4% for venous stroke, and 0.6% for hemorrhagic stroke). The highest stroke incidence was observed in the group of patients receiving heparin. In contrast, the prevention of thrombotic complications in patients receiving low-molecular-weight anticoagulants or rivaroxaban showed the best results with minimal morbidity and mortality in severe COVID-19.

Conclusion. Stroke can be a complication of COVID-19, and preventive anticoagulant therapy using low-molecular-weight heparin or a factor X inhibitor effectively prevents this complication.

About the Authors

A. T. Azimov
JCI accredited medical center AKFA Medline
Uzbekistan

Anvar Tairovich Azimov

Department of neurology

5А, Kichik Khalka Iuli St., Almazar district, Tashkent 100054



G. S. Rakhimbaeva
Tashkent Medical Academy
Uzbekistan

Department of neurology

2, Farobi St., Tashkent 100109



F. Z. Azimov
JCI accredited medical center AKFA Medline
Uzbekistan

Department of neurology

5А, Kichik Khalka Iuli St., Almazar district, Tashkent 100054



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For citation:


Azimov A.T., Rakhimbaeva G.S., Azimov F.Z. Anticoagulant therapy for stroke prevention in patients with severe COVID-19. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):20-25. (In Russ.) https://doi.org/10.14412/2074-2711-2021-5-20-25

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)