Catastrophic retroperitoneal hemorrhage in COVID-19 patients under anticoagulant prophylaxis

Javid, Amir; Kazemi, Reza; Dehghani, Mehdi; Samani, Hossein Bahrami

doi:10.1016/j.eucr.2021.101568

Cited by 21 publications

(12 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5, performed according to PRISMA criteria, 21 17 studies were included in qualitative and quantitative syntheses. 16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The systematic review identified 40 patients with COVID-19 complicated by muscular hematomas.…”

Section: Systematic Reviewmentioning

confidence: 99%

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Abate

Casoria

Rendina

et al. 2021

Semin Thromb Hemost

View full text Add to dashboard Cite

Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.

show abstract

Section: Systematic Reviewmentioning

confidence: 99%

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Abate

Casoria

Rendina

et al. 2021

Semin Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…On the other hand, various hemorrhagic conditions have been reported in COVID-19 patients. Recently, case reports have been published about the development of retroperitoneal hemorrhage in COVID-19 patients while receiving anticoagulation [ 6 – 8 ] or during extracorporeal membrane oxygenation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients

Mahboubi-Fooladi

Arabi

Khazaei

et al. 2021

SN Compr. Clin. Med.

View full text Add to dashboard Cite

Since coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state, especially in critical patients, anticoagulation is used for thromboprophylaxis. Hemorrhagic complications, even uncommon ones such as retroperitoneal hemorrhage, can occur following anticoagulant administration. We present 5 patients with COVID-19 whose clinical course was complicated by spontaneous retroperitoneal hemorrhage. The patients were initially presented with respiratory manifestations of the infection. There was no history or evidence suggestive for traumatic injury. After hospitalization, the patients received supplemental oxygen, antibiotics, enoxaparin or heparin, interferon beta-1b (in three patients), and anticoagulation with subcutaneous injection of enoxaparin (three patients) or heparin (two patients). During the course of hospitalization, the patients showed sudden-onset abdominal pain (three cases), hypotension (three cases), and an acute drop in hemoglobin level. CT scan of the abdomen and pelvis revealed retroperitoneal hemorrhage. For one patient, owing to unstable vital signs and an expanding hematoma, surgical intervention was performed. Others were managed conservatively with discontinuation of anticoagulants, intravenous (IV) fluid resuscitation, and packed red blood cells transfusion. Three patients died due to worsening of the infection and respiratory failure. Retroperitoneal hemorrhage could be a potential complication in COVID-19 patients receiving anticoagulation. Careful monitoring of the vital signs and blood tests like hemoglobin level of such patients is essential.

show abstract

“…The data from the 11 Caucasian patients described in 4 references revealed unilateral hematoma, with 8 patients receiving therapeutic doses of heparin and 5 requiring TAE. However, to our knowledge, few reports have described bilateral iliopsoas hematomas or SMH in other races or patients treated with UFH as an anticoagulant (12). In patients with COVID-19, SMH is an important complication, regardless of race or the type of anticoagulant administered.…”

Section: Figure Radiological Findings In Two Cases Axial (A) and Coronal Sections (B) Of The Cect Arterial Phase In Case 1 Revealed Bilatmentioning

confidence: 97%

Spontaneous Muscle Hematoma in Japanese Patients with Severe COVID-19 Treated with Unfractionated Heparin: Two Case Reports

et al. 2021

View full text Add to dashboard Cite

In hospitalized coronavirus disease 2019 (COVID-19) patients, anticoagulation therapy is administered to prevent thrombosis. However, anticoagulation sometimes causes bleeding complications. We herein report two Japanese cases of severe COVID-19 in which spontaneous muscle hematomas (SMH) developed under therapeutic anticoagulation with unfractionated heparin. Although the activated partial prothrombin time was within the optimal range, contrast-enhanced computed tomography (CECT) revealed SMH in the bilateral iliopsoas muscles in both cases, which required emergent transcatheter embolization. Close monitoring of the coagulation system and the early diagnosis of bleeding complications through CECT are needed in severe COVID-19 patients treated with anticoagulants.

show abstract

Catastrophic retroperitoneal hemorrhage in COVID-19 patients under anticoagulant prophylaxis

Cited by 21 publications

References 5 publications

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients

Spontaneous Muscle Hematoma in Japanese Patients with Severe COVID-19 Treated with Unfractionated Heparin: Two Case Reports

Contact Info

Product

Resources

About