Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study

Nakamura, Junichi; Tsujino, Ichizo; Yachi, Sen; Takeyama, Makoto; Nishimoto, Yuji; Konno, Satoshi; Yamamoto, Naoto; Nakata, Hiroko; Ikeda, Satoshi; Umetsu, Michihisa; Aikawa, Shizu; Hayashi, Hiroya; Satokawa, Hirono; Okuno, Yoshinori; Iwata, Eriko; Ogihara, Yoshito; Ikeda, Nobutaka; Kondo, Akane; Iwai, Takehisa; Yamada, Norikazu; Ogawa, Tomohiro; Kobayashi, Takao; Mo, Makoto; Yamashita, Yugo

doi:10.1186/s12959-022-00414-x

Cited by 11 publications

(10 citation statements)

References 48 publications

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“…Although the role of a percussive device in the development of an RSH in this patient is uncertain, we feel it may have been at least a contributing factor. The possible risk of using such devices in patients with severe COVID-19 who are on anticoagulant therapy must be considered, as these patients have a high incidence of major bleeding [10], including spontaneous RSHs [4]. Indeed, the retrospective study by Emekli et al [3] of 9,876 hospitalized COVID-19 patients receiving anticoagulants identified 0.12% (12 patients) who developed RSHs, with anticoagulant use ranging from 4 to 10.75 days at therapeutic doses.…”

Section: Discussionmentioning

confidence: 99%

Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy: A Case Report

Kwon

2024

Biomed Hub

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Introduction: Rectus sheath hematomas (RSHs) can occur from the rupture of the epigastric arteries, leading to blood accumulation within the rectus abdominis sheath. Herein, we report the unique case of an RSH resulting in acute ureteral obstruction, which was associated with the use of a handheld deep-tissue percussive massage device in attempts to relieve abdominal pain. Case Report: A morbidly obese man in his late 50s was admitted with complications of COVID-19, including acute respiratory syndrome, bilateral peroneal deep vein thromboses, and acute kidney injury. He was treated with anticoagulants (subcutaneous enoxaparin and apixaban), dexamethasone, and remdesivir. He developed severe abdominal pain, and a large (14 × 17 cm) right rectus sheath and an extraperitoneal pelvic hematoma were identified by computed tomography. The hematoma extended across the midline into the left pelvis and the retroperitoneum with associated mild right hydronephrosis. A handheld percussive massage device (Theragun®) was applied repeatedly at the site of enoxaparin injection into the abdominal wall in attempts to alleviate the pain. On day 12, bilateral nephrostomy tubes were inserted. A nephrostogram revealed mild hydroureteronephrosis to the ureterovesicular junction bilaterally and extrinsic compression of the bladder. On day 17, the patient suffered a cardiac arrest and died. Conclusion: This case report offers insights into the pathophysiology of obstructive uropathy and is a reminder of the importance of considering uncommon causes of obstructive uropathy in the diagnosis and management of AKI, particularly in hospitalized patients receiving anticoagulation. We know of no previous reference of obstructive uropathy caused by retroperitoneal hematoma associated with the use of a portable massage device applied to the abdominal wall.

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Section: Discussionmentioning

confidence: 99%

Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy: A Case Report

Kwon

2024

Biomed Hub

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“… 4 ) Independent factors for major bleeding have been reported, including a history of major bleeding, severe COVID-19 infection, and use of anticoagulants. 12 ) Anticoagulation in these patient groups requires more caution. When the risk of bleeding decreases, it may be necessary to consider the resumption of appropriate anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

“… 9 ) Thrombus development was associated with COVID-19 severity, and bleeding risk was related to COVID-19 severity and anticoagulation but not with age. 10 – 12 )…”

Section: Introductionmentioning

confidence: 99%

Clinical Features Comparing Arterial Thrombosis and Venous Thromboembolism in Hospitalized Patients with COVID-19: Result from the CLOT-COVID Study

Umetsu

Kanamori

Murakami

et al. 2023

Annals of Vascular Diseases

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Objectives: This study aimed to investigate the clinical features of arterial thrombosis and venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19). Methods: The CLOT-COVID Study was a retrospective, multicenter cohort study that enrolled 2,894 consecutively hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. We compared the clinical features of arterial thrombosis and VTE. Results: Thrombosis was observed in 55 patients (1.9%) during hospitalization. Arterial thrombosis and VTE occurred in 12 (0.4%) and 36 (1.2%) patients, respectively. Among the 12 patients with arterial thrombosis, 9 (75%), 2 (17%), and 1 developed ischemic cerebral infarction, myocardial infarction, and acute limb ischemia, respectively, and there were five patients (42%) without comorbidities. Among 36 patients with VTE, 19 (53%) and 17 (47%) developed pulmonary embolism (PE) and deep vein thrombosis (DVT), respectively. PE was common in the early stages of hospitalization; whereas, DVT was common beyond the early stages of hospitalization. Conclusion: Among patients with COVID-19, arterial thrombosis was less common than VTE, although ischemic cerebral infarction seemed to be relatively common, and a certain number of patients developed arterial thrombosis even in the absence of known atherosclerosis risk factors.

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“…Other clinical outcomes aside from thrombosis could also be important when considering anticoagulation therapy. A previous study showed that the incidence of major bleeding was not uncommon, especially in patients with severe COVID-19, and independent risk factors for major bleeding included history of major bleeding, COVID-19 severity, and anticoagulant use, which could be associated with poor clinical outcomes, including higher mortality 61) . Another previous study reported several independent risk factors for mortality in hospitalized patients with COVID-19, such as age ＞70 years, high D-dimer values on admission, heart disease, active cancer, higher COVID-19 severity on admission, and development of major bleeding during hospitalization, which could facilitate appropriate risk stratification of COVID-19 patients 62) .…”

Section: L I N I C a L Ev I D E N C E S O F T H R O M B O S I S A N D...mentioning

confidence: 99%

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

Yamashita

Kobayashi

2023

JAT

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Coronavirus disease 2019 (COVID-19) has become a major health problem worldwide since 2020.Although the main pathophysiology of COVID-19 is a respiratory infectious disease, it could also cause cardiovascular complications, including thrombosis. Thus, anticoagulation therapy has been thought to help prevent thrombosis, leading to improved survival. However, to date, several aspects of the optimal anticoagulation strategies for COVID-19 remain unclear. Considering the status of COVID-19-related thrombosis and some domestic issues in Japan, the optimal anticoagulation strategies for COVID-19 might have to be based on Japanese domestic clinical data considering racial difference. Racial disparities in terms of thromboembolic risk have been well known in the pre-COVID-19 era, and the risk of COVID-19-associated thrombosis depending on race could be an important issue. Considering a potential higher risk of bleeding with anticoagulation therapy in the Asian population, it might be important to maintain a good balance between the risks of thrombosis and bleeding. Latest evidences of COVID-19-related thrombosis and anticoagulation strategies, including some domestic issues in Japan, showed a different status of COVID-19-related thrombosis in Japan from that in Western countries, suggesting the potential benefit of different anticoagulation strategies, specifically for the Japanese population. Although these insights could be useful for the consideration of anticoagulation strategies for the Japanese population, the final decision should be based on balancing the benefits and risks of anticoagulation therapy in each patient.

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Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study

Cited by 11 publications

References 48 publications

Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy: A Case Report

Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy: A Case Report

Clinical Features Comparing Arterial Thrombosis and Venous Thromboembolism in Hospitalized Patients with COVID-19: Result from the CLOT-COVID Study

Thrombosis and Anticoagulation Strategies in Patients with COVID-19 Including Japanese Perspective

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