Characteristics of Coagulation/Fibrinolysis Abnormalities in Serious Corona Virus Disease 2019 (COVID-19) Patients Complicated with Stroke: Case Series

Abstract Background: Not surprisingly, novel coronavirus disease 2019 (COVID-19) patients are frequently complicated with COVID-19 associated coagulopathy (CAC). And cerebrovascular disease is not uncommon during SARS-CoV-2 infection, especially in older patients and severe patients with risk factors. This time we treated six patients with serious COVID-19, of whom two had a stroke during ICU admission. Based on our experience, we report some findings on the relationship between CAC pattern and risk of stroke in patients with serious COVID-19.Case presentation: Two patients who subsequently had a stroke were transferred to our emergency center and underwent veno-venous extracorporeal corporeal membrane oxygenation (V-V ECMO) with unfractionated heparin as an anticoagulant for treatment of severe respiratory failure. In one patient, the platelet count was 5.7 × 104/mm3 on ICU admission, increased to above 10 × 104/mm3 after 5 days. In the other patient, the platelet count progressed to above 10 × 104/mm3 for the observation period of 8 days. Both prothrombin-international normalized ratio and activated partial thromboplastin time remained almost within the normal ranges throughout the 8-day period. In contrast, the levels of fibrin degradation products, D-dimer, and plasmin alfa2-plasmin inhibitor complex remained above the upper limits of the normal ranges throughout the 8-day period, and the levels in both cases increased markedly around the onset of stroke.Discussion: From these findings, we gained a strong impression that the pattern of CAC in stroke patients was not a “suppressed-fibrinolytic type” pattern, but rather an “enhanced-fibrinolytic type” pattern.Conclusions: During the period in which serious COVID-19 patients undergo V-V ECMO, we need to be aware that these patients with CAC may be complicated with stroke not only cerebral infarction, but also cerebral hemorrhage.