Anticoagulation versus Antiplatelet Therapy in COVID-19-Related Stroke: Navigating Clinical Dilemmas in a Critically Ill Cirrhotic Patient - A Case Report.

IF 0.6 Q4 CLINICAL NEUROLOGY

Case Reports in Neurology Pub Date : 2026-02-26 eCollection Date: 2026-01-01 DOI:10.1159/000551122

Bo-Ying Huang, Kuan-Hung Lin, Kuan-Hsien Lu, Wen-Wen Tsai

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引用次数: 0

Abstract

Introduction: The aim of this was to illustrate the treatment dilemma when coronavirus disease 2019 (COVID-19)-related thromboinflammatory stroke occurs in a patient with cirrhosis and to highlight a mechanism-guided framework for choosing between antiplatelet and anticoagulant therapy.

Case presentation: A 75-year-old man with alcoholic cirrhosis and esophageal varices was hospitalized for severe COVID-19 pneumonia. Because his D-dimer exceeded 3,000 ng/mL, prophylactic low-molecular-weight heparin (LMWH) was started. On day 4, he developed an acute right middle cerebral artery M2 occlusion (Alberta Stroke Program Early CT Score, ASPECTS 4); reperfusion therapy was contraindicated. A multidisciplinary team opted to continue LMWH and withhold antiplatelet agents, reasoning that thromboinflammation - not atherosclerosis - was the likely mechanism and that variceal bleeding risk was high. Acute kidney injury emerged on day 6, but careful monitoring showed neither hemorrhage nor stroke progression. The patient later died from respiratory failure unrelated to the stroke.

Conclusion: In COVID-19 stroke with cirrhosis, guideline antiplatelet therapy may not fit the underlying biology. Treatment should be mechanism-guided, biomarker-informed, and adjusted to individual bleeding risk.

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抗凝与抗血小板治疗在covid -19相关卒中中的应用：在重症肝硬化患者中导航临床困境-一个病例报告

前言：本研究的目的是阐明肝硬化患者发生冠状病毒病2019 （COVID-19）相关血栓炎性卒中时的治疗困境，并强调在抗血小板和抗凝治疗之间选择的机制指导框架。病例介绍：一名75岁男性，酒精性肝硬化并食管静脉曲张，因重症COVID-19肺炎住院。由于他的d -二聚体超过3000 ng/mL，预防性使用低分子肝素（LMWH）。第4天，患者出现急性右大脑中动脉M2闭塞（Alberta Stroke Program Early CT Score, ASPECTS 4）；再灌注治疗是禁忌。一个多学科团队选择继续低分子肝素治疗，并保留抗血小板药物，理由是血栓炎症（而不是动脉粥样硬化）是可能的机制，并且静脉曲张出血的风险很高。第6天出现急性肾损伤，但仔细监测未发现出血和中风进展。病人后来死于与中风无关的呼吸衰竭。结论：在COVID-19卒中合并肝硬化患者中，指南抗血小板治疗可能不符合基础生物学。治疗应以机制为指导，以生物标志物为依据，并根据个体出血风险进行调整。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Case Reports in Neurology Medicine-Neurology (clinical)

CiteScore

1.50

自引率

0.00%

发文量

审稿时长

14 weeks

期刊介绍： This new peer-reviewed online-only journal publishes original case reports covering the entire spectrum of neurology. Clinicians and researchers are given a tool to disseminate their personal experience to a wider public as well as to review interesting cases encountered by colleagues all over the world. To complement the contributions supplementary material is welcomed. The reports are searchable according to the key words supplied by the authors; it will thus be possible to search across the entire growing collection of case reports with universally used terms, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.