Microthrombosis associated with GI bleeding in COVID-19

Abstract

A 35-year-old man with sickle-cell trait and diabetes who had undergone renal transplantation presented with weeks of episodic severe cramping, abdominal pain, diarrhea, maroon stool, and anorexia despite using empiric antibiotics for gastroenteritis. At presentation, his laboratory results noted a mild leukocytosis and a hemoglobin of 6.4 g/dL. Real-time polymerase chain reaction of a nasopharyngeal sample gave a positive result for SARS-CoV-2 despite the lack of respiratory symptoms or fever. A CT scan demonstrated diffusely thickening of the stomach and small-bowel walls (A). Upper endoscopy revealed normal gastric mucosa but edematous, friable duodenal mucosa with contact bleeding (B). Examination of biopsy specimens from the duodenal mucosa demonwww.giejournal.org Volume-, No.-: 2020 GASTROINTESTINAL ENDOSCOPY 1 our knowledge, this is the first endoscopic description of biopsy-confirmed COVID-19-associated microthrombosis, reinforcing the importance of endoscopy with adequate biopsy.

Management of therapeutic unfractionated heparin in COVID‐19 patients: A retrospective cohort study

“…[42][43][44] Prospective investigations We observed higher incidence of both major and CRNMB in patients who were COVID-19 positive compared to patients who were COVID-19 negative. This is consistent with published accounts indicating that while spontaneous bleeding events do occur in patients who are COVID-19 positive such as diffuse alveolar hemorrhage 45 and microthrombosis-associated 46 hemorrhage, bleeding in COVID-19 is most often in the context of prophylactic 12,47 and therapeutic 47,48 anticoagulation. Our results are also consistent with data from other centers that have noted high rates of bleeding among patients with COVID-19 receiving therapeutic anticoagulation.…”

Risk factors for severity of COVID-19 in hospital patients age 18–29 years

“…Pneumonia and component disease diagnoses were classified according to ICD-10-CM definitions, regardless of the presence of a U07.1 code (COVID-19, virus identified). The composite disease definition included the following diagnoses: sepsis [17], myocardial infarction [18], cerebrovascular event [19], cardiac arrest, pulmonary embolism [20], thrombosis [21], acute respiratory distress syndrome (ARDS) [22], acute respiratory failure (ARF) [23], pneumothorax [24], gastrointestinal bleed [25], acute kidney injury, hypoxemia, shock, or systemic inflammatory response syndrome (SIRS) [26]. The presence of at least one of the listed diagnoses was sufficient for a 'severe disease' classification.…”

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

“…Limited data are available regarding the outcomes of GIB in these patients, and the evidence is limited to small observational studies, case series, and case reports. [11][12][13][14][15][16][17][18][19][20][21] Therefore, we performed a systematic review and meta-analysis to evaluate the etiology, management, and outcomes of COVID-19 patients who had signs and symptoms of GIB.…”