Association of coagulation factors profile with clinical outcome in patient with COVID-19 and acute stroke: A second wave cohort study

Abstract

INTRODUCTION: The second wave of COVID-19 in Indonesia occurred due to delta variant transmission with up to 2266 cases. This variant could cause higher rate of morbidities and mortalities. This study reported coagulation profile of COVID-19 patients with acute stroke and its association with patients’ outcome. METHOD: This is a cohort-retrospective study conducted during the second wave of COVID-19, June-August 2021 in Cipto Mangunkusumo General Hospital. Inclusion criteria were adult patients with confirmed COVID-19 and diagnosed with acute stroke confirmed by radiological evidences. Exclusion criteria were COVID-19 patients with prior diagnosis of acute stroke. Coagulation factors were analyzed and presented with tables and graphs. RESULTS: A total of 33 patients included in this study with majority experienced ischemic stroke (84.8%), followed by ischemic with haemorrhagic transformation (9.1%), and the rest with haemorrhagic stroke. The median of fibrinogen and D-dimer was 487.1(147–8,943)mg/dL and 2,110(250–35,200)ug/L respectively. Prothrombin time (PT) ratio was 0.95(0.82–1.3) and activated partial thromboplastin time (APTT) ratio was 1.01(0.64–2.72). On observation, 33.3% died during hospitalization, D-dimer value in these patients was significantly higher with 9,940ug/L compared to those who survived with 1,160ug/L(p = 0.009). The highest D-dimer value during hospitalization was also significantly higher with the median of 14,395ug/L compared to 3,740 ug/L (p = 0.014). DISCUSSION: D-dimer value on initial assessment and its highest value during hospitalization were significantly higher in patient with poor outcome, showing that D-dimer can be one predictor of mortality in COVID-19 patients with acute stroke

Predictive value of inflammatory and coagulation biomarkers for venous thromboembolism in COVID-19 patients

“…Among those, neutrophil to lymphocyte ratio (NLR) emerged as a cost-effective predictor of complications and high values suggest poor prognosis in patients with severe Covid-19 [2,6]. The hypercoagulable state is characterised by an increased D-dimer, fibrinogen and prothrombin time, which <ins cite="mailto:User" datetime="2022-12-18T21 : 00">along with blood hyperviscosity</ins> leads to <ins cite="mailto:User" datetime="2022-12-18T21 : 01">venous and arterial</ins> thrombotic complications [7][8][9][10][11][12][13][14]. Among Covid-19 patients a higher incidence of venous thromboembolisms (VTE) has been observed across studies, however the reported prevalence rate varies greatly, ranging from 8 to 76% for pulmonary embolism (PE) and from 7 to 85% for deep vein thrombosis (DVT), with a higher prevalence among ICU patients [15][16][17][18][19][20].…”

Oral manifestations of COVID-19: A review

“…The coagulation profile of COVID-19 patients who had an acute stroke and its relationship to patients' outcomes were reported in a study. The baseline D-dimer value and its peak value during hospitalisation were significantly greater in patients who had a poor outcome, demonstrating that the D-dimer can be a predictor of death in COVID-19 patients with acute stroke [25].…”

Luaran Pasien Stroke Iskemik Akut Dengan Infeksi Covid-19 Di Jakarta

“…[10] Oleh sebab itu rekomendasi pemberian antikoagulan dapat diberikan pada pasien stroke iskemik akut dengan infeksi COVID-19 dengan kadar Ddimer yang tinggi. [10,16] Tatalaksana stroke iskemik dengan infeksi COVID-19 pada penelitian ini pada prinsipnya sama dengan stroke iskemik tanpa COVID-19 yaitu dengan pemberian antiplatelet pada sebagian besar pasien (83,3%). Adapun terapi trombolisis tidak tercantum pada data penelitian, karena di rumah sakit ini belum tersedia.…”