Unfractionated Heparin in SARS-CoV-2 Pneumonia: Ischemic Stroke Case Report

Abstract

Thromboembolism is a known phenomenon in patients with Coronavirus disease 2019 (COVID-19). Recent investigations have revealed that a significant proportion of those hospitalized with severe COVID-19 demonstrate clinical and laboratory markers compatible with hypercoagulability, which is differentiated from disseminated intravascular coagulation (DIC), termed COVID-associated coagulopathy. Additionally, there is increasing concern for development of acute ischemic stroke because of this hypercoagulable state. We present a patient with COVID-19 pneumonia who was managed with unfractionated heparin (UFH) infusion and developed a large ischemic infarct shortly after cessation of the infusion. In retrospect, the patient's coagulation parameters were consistent with overt DIC, although some of these parameters are easily masked by the effects of UFH. These findings emphasize the importance of anticoagulation as well as its careful discontinuation, as failure to do so may result in a significant thromboembolic event.

Heparan Sulfate Facilitates Spike Protein-Mediated SARS-CoV-2 Host Cell Invasion and Contributes to Increased Infection of SARS-CoV-2 G614 Mutant and in Lung Cancer

“…However, when ACE2 expression is high, the HS coreceptor function is dispensable. Some studies have reported that interferon-mediated induction of ACE2 expression occurs upon SARS-CoV-2 infection (Fu et al, 2020;Su and Jiang, 2020;Tan et al, 2020), suggesting that blocking HS-SV2-S binding by heparin may not be sufficient (Efendizade et al, 2020;Hippensteel et al, 2020;Menezes-Rodrigues et al, 2020) and would need to be combined with other mechanism-based agents to most effectively to treat and/or prevent COVID-19.…”

A case-based systematic review on the SARS-COVID-2-associated cerebrovascular diseases and the possible virus routes of entry

“…The remaining 71 articles (127 patients) that satisfied the criteria mentioned above were included in this review. In this review, 80 cases of patients developed IS during COVID-19 infection (Aasfara et al 2021 ; Abdulkadir et al 2020 ; Agarwal et al 2020 ; Al-Mufti et al 2021 ; Al Saiegh et al 2020 ; Appavu et al 2021 ; Ashraf and Sajed 2020 ; Avula et al 2020 ; Bessa et al 2020 ; Bigliardi et al 2020 ; Burkert and Patil 2020 ; Co et al 2020 ; Dakay et al 2020a , b ; de Almeida Lima et al 2020 ; de Lorenzo Alvarez et al 2021 ; Deliwala et al 2020 ; Dumitrascu et al 2020 ; Efendizade et al 2020 ; El Nahas et al 2020 ; Elshereye and Erdinc 2020 ; Eskandarani et al 2021 ; Fu et al 2021 ; Garg et al, 2020 ; Gemcioglu et al 2020 ; Goette et al 2020 ; Goldberg et al 2020 ; Guillan et al 2020 ; Iqbal et al 2021 ; Kwon et al 2020 ; Mahboob et al 2020 ; Mansour et al 2020 ; Mirzaee et al 2020 ; Morassi et al 2020 ; Mowla et al 2020 ; Patel et al 2020a , b ; Patel et al 2020a , b ; Prasad et al 2021 ; Priftis et al 2020 ; Rajdev et al 2020 ; Rascón-Ramírez et al 2020 ; Roy et al 2021 ; Valderrama et al 2020 ; Viguier et al 2020 ; Zhai et al 2020 ), 32 cases developed intracranial hemorrhage (Ahmad et al 2021 ; Al-Mufti et al 2021 ; Al Saiegh et al 2020 ; Carroll and Lewis 2021 ; Cezar-Junior et al 2020 ; Dakay et al 2020a , b ; Dakay et al 2020a , ...…”