Neurology, Neuropsychiatry, Psychosomatics

Advanced search

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

Full Text:


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

Anvar Tairovich Azimov

Department of neurology

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

G. S. Rakhimbaeva
Tashkent Medical Academy

Department of neurology

2, Farobi St., Tashkent 100109

F. Z. Azimov
JCI accredited medical center AKFA Medline

Department of neurology

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


1. Temporary recommendations for the management of patients infected with COVID-19 (fifth version). Ministry of Health of the Republic of Uzbekistan, National Chamber of Innovative Healthcare of the Republic of Uzbekistan. 2020. Available from:временные-рекомендации-по-ведению-пациентов-инфицированных-covid-19-пятая-версия-кп-узбекистан-2020/16535 (In Russ.).

2. Andreev VV, Podunov AYu, Lapin DS, et al. Clinical and pathogenetic features of cerebral stroke in patients with new corоnavirus infection (COVID-19). Regionarnoye krovoobrashcheniye i mikrotsirkulyatsiya = Regional Blood Circulation and Microcirculation. 2020;19(3):46-56. doi: 10.24884/1682-6655-2020-19-3-46-56 (In Russ.).

3. Pizova NV, Pizov NA, Skachkova OA, et al. Acute cerebral circulatory disorders and coronavirus disease. Meditsinskiy sovet = Medical Council. 2020;(8):18-25. doi: 10.21518/2079-701X-2020-8-18-25 (In Russ.).

4. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683-90. doi: 10.1001/jamaneurol.2020.1127

5. Benussi A, Pilotto A, Premi E, et al. Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology. 2020 Aug 18;95(7):e910-e920. doi: 10.1212/WNL.0000000000009848. Epub 2020 May 22.

6. Yaghi S, Ishida K, Torres J, et al. SARS2-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020 Jul;51(7):2002-11. doi: 10.1161/STROKEAHA.120.030335. Epub 2020 May 20.

7. Katsanos AH, Palaiodimou L, Zand R, et al. The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis. Ann Neurol. 2021 Feb;89(2):380-8. doi: 10.1002/ana.25967. Epub 2020 Dec 9.

8. Abootalebi S, Aertker BM, Andalibi MS, et al. Call to Action: SARS-CoV-2 and CerebrovAscularDisordErs (CASCADE). J Stroke Cerebrovasc Dis. 2020 Sep;29(9):104938. doi: 10.1016/j.jstrokecerebrovasdis.2020.104938. Epub 2020 May 8.

9. Beyrouti R, Adams ME, Benjamin L, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry. 2020 Aug;91(8):889-91. doi: 10.1136/jnnp2020-323586. Epub 2020 Apr 30.

10. Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. Engl J Med. 2020 Jun 4;382(23):2268-70. doi: 10.1056/NEJMc2008597. Epub 2020 Apr 15.

11. Mehta JL, Calcaterra G, Bassareo PP. COVID-19, thromboembolic risk, and Virchow's triad: Lesson from the past. Clin Cardiol. 2020 Dec;43(12):1362-7. doi: 10.1002/clc.23460. Epub 2020 Nov 11.

12. Qureshi AI, Abd-Allah F, Al-Senani F, et al. Management of acute ischemic stroke in patients with COVID-19 infection: report of an international panel. Int J Stroke. 2020 Jul;15(5):540-54. doi: 10.1177/1747493020923234. Epub 2020 May 3.

13. Baldini T, Asioli GM, Romoli M, et al. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. Eur J Neurol. 2021 Jan 11;10.1111/ene.14727. doi: 10.1111/ene.14727. Online ahead of print.

14. Li Y, Wang M, Zhou Y, et al. Acute cerebrovascular disease following COVID-19: A single center, retrospective, observational study. Stroke Vasc Neurol. 2020 Sep;5(3):279-84. doi: 10.1136/svn-2020-000431. Epub 2020 Jul 2.

15. AHA/ASA Stroke Council Leadership. Temporary Emergency Guidance to US Stroke Centers During the Coronavirus Disease 2019 (COVID-19) Pandemic: On Behalf of the American Heart Association/American Stroke Association Stroke Council Leadership. Stroke. 2020 Jun;51(6):1910-2. doi: 10.1161/STROKEAHA.120.030023. Epub 2020 Apr 1.

16. Ghannam M, Alshaer Q, Al-Chalabi M, et al. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol. 2020 Nov;267(11):3135-53. doi: 10.1007/s00415-020-09990-2. Epub 2020 Jun 19.

17. Avula A, Nalleballe K, Narula N, et al. COVID-19 presenting as stroke. Brain Behav Immun. 2020 Jul;87:115-9. doi: 10.1016/j.bbi.2020.04.077. Epub 2020 Apr 28

18. Aghayari Sheikh Neshin S, Shahjouei S, Koza E, et al. Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology. Front Cardiovasc Med. 2021 Mar 29;8:649922. doi: 10.3389/fcvm.2021.649922. eCollection 2021.


For citations:

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.)

Views: 453

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

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