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Coronavirus disease 2019 (COVID-19) is associated with hyper-coagulopathy, and appropriate anticoagulant therapy is needed to improve the condition of patients with venous thromboembolism. Spontaneous intracranial hemorrhage, including non-aneurysmal subarachnoid hemorrhage (SAH), occurs in patients with severe COVID-19. Harrogate et al. reported two such cases in patients with severe COVID-19 [1] and recommended careful observations for detecting non-aneurysmal SAH in patients with anticoagulant therapy. I present information regarding case reports in COVID-19 patients with non-aneurysmal SAH with special reference to anticoagulant therapy.
Batcik et al. reported cases of four patients with COVID-19 who experienced spontaneous non-aneurysmal SAH, which was observed in the early and late stages of COVID-19 infection [2]. They recognized two cases with anticoagulant therapy. Altschul et al. reported two cases of COVID-19 patients with SAH, and one case received anticoagulant therapy [3]. Given that disseminated intravascular coagulopathy and severe bleeding events are uncommon in patients in any stage of COVID-19 infection [4], anticoagulant therapy should be evaluated by multivariate analysis to determine whether it is a major risk factor for non-aneurysmal SAH.
Some triggers might exist in patients with COVID-19 and SAH in relation to host immune responses and immune-related symptoms [5]. Regardless, preventing non-aneurysmal SAH in patients with COVID-19 is important and should be explored in further studies.
References
Harrogate S, Mortimer A, Burrows L, Fiddes B, Thomas I, Rice CM (2021) Non-aneurysmal subarachnoid haemorrhage in COVID-19. Neuroradiology. 63(1):149–152
Batcik OE, Kanat A, Cankay TU, Ozturk G, Kazancıoglu L, Kazdal H, Gundogdu H, Ozdemir B, Bahceci I, Kostakoglu U, Batcik S, Gundogdu O, Sevilgen G (2021) COVID-19 infection produces subarachnoid hemorrhage; acting now to understand its cause: a short communication. Clin Neurol Neurosurg 202:106495
Altschul DJ, Unda SR, de La Garza RR, Zampolin R, Benton J, Holland R, Fortunel A, Haranhalli N (2020) Hemorrhagic presentations of COVID-19: risk factors for mortality. Clin Neurol Neurosurg 98:106112
Wool GD, Miller JL (2021) The impact of COVID-19 disease on platelets and coagulation. Pathobiology. 88(1):15–27
Fajgenbaum DC, June CH (2020) Cytokine storm. N Engl J Med 383(23):2255–2273
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This letter is a response to article 10.1007/s00234-020-02535-4
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Kawada, T. Letter regarding “Non-aneurysmal subarachnoid hemorrhage in patients with COVID-19”. Neuroradiology 63, 833 (2021). https://doi.org/10.1007/s00234-021-02700-3
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DOI: https://doi.org/10.1007/s00234-021-02700-3