Spontaneous Bleedings in COVID-19 Patients: An Emerging Complication

Bargellini, Irene; Cervelli, Rosa; Lunardi, Alessandro; Scandiffio, Rossella; Daviddi, Francesco; Giorgi, Luigi; Cicorelli, Antonio; Crocetti, Laura; Cioni, Roberto

doi:10.1007/s00270-020-02507-4

Cited by 40 publications

(35 citation statements)

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“…They all underwent coil embolization. The authors suggested a traumatic mechanism underlying the bleeding in two cases (mobilization in the prone position in the first one, electrical cardioversion in the second one) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review

et al. 2020

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Background In late December 2019, a cluster of pneumonia cases due to a novel betacoronavirus, SARS-CoV-2 was reported in China. The so-called COVID 19 is responsible not only for respiratory symptoms, from mild up to pneumonia and even acute respiratory distress syndrome, but also for extrapulmonary involvement. Cases presentation Here we present two cases of spontaneous muscle hematoma in patients with SARS-CoV-2 infection, both on therapeutic LMWH for atrial fibrillation: the first one was an 86-year-old Caucasian female with a history of hypertensive cardiomyopathy and the second one was an 81-year-old Caucasian male with a history of hypertension, diabetes and ischemic heart disease. Blood tests revealed a considerable drop of hemoglobin and alterations of coagulation system. In both cases, embolization of femoral artery was performed. A few other cases of bleeding manifestations are reported in literature, while a lot has been published about the hypercoagulability related to COVID-19. Conclusions Our reports and literature review highlight the need of active surveillance for possible hemorrhagic complications in patients with SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review

et al. 2020

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“…Although the principal cause of mortality is acute respiratory insufficiency, concern exists over the association between severe acute respiratory syndrome coronavirus 2 infection and coagulopathy that can precipitate disseminated intravascular coagulation ( 1 ). Local thrombi in the lungs and other organs are considered to be distinctive of severe COVID-19, which are responsible for the clinical manifestations of the disease related to ischemic damage ( 2 ). Anticoagulants have therefore become part of the medical therapy in hospitalized patients, and this may increase the risk of spontaneous bleeding.…”

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confidence: 99%

Gastrointestinal Hemorrhages in Patients With COVID-19 Managed With Transarterial Embolization

Ierardi

Giudice²,

Coppola

et al. 2020

Am J Gastroenterol

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“…Recently, a retrospective study in no COVID patients showed an incidence of IPHs of 3.8 cases per 1000 admission in ICUs [ 9 ] and our incidence of 7.6 cases over 1000 hospitalization, is higher than that previously reported. Risk factors in our small case series are the same reported in literature, as age, anticoagulation, a high body mass index, comorbidities such as hypertension and diabetes [ 9 , 13 , 14 ], moreover, our patients had an activated partial thromboplastin time (aPTT) above the therapeutic range at the moment of the diagnosis of the IPHs. Disseminated intravascular coagulopathy (DIC) and increased aPTT are both independent predictors of unfavourable prognosis [ 9 ].…”

Section: Discussionmentioning

confidence: 57%

Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients

et al. 2021

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Introduction Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. Materials and methods We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy. Results Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis. Conclusions Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.

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Spontaneous Bleedings in COVID-19 Patients: An Emerging Complication

Cited by 40 publications

References 1 publication

Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review

Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review

Gastrointestinal Hemorrhages in Patients With COVID-19 Managed With Transarterial Embolization

Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients

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