Spontaneous retroperitoneal bleeding in COVID-19 patients – two case reports
Authors:
R. Pálek 1,2; J. Rosendorf 1,2; V. Třeška 1
Authors‘ workplace:
Chirurgická klinika, Fakultní nemocnice Plzeň, Lékařská fakulta v Plzni, Univerzita Karlova
1; Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova
2
Published in:
Rozhl. Chir., 2021, roč. 100, č. 12, s. 607-611.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.12.607–611
Overview
Introduction: COVID-19 disease is associated with a high risk of thromboembolic events, especially in patients with a severe course of the disease. At the same time, however, there is a risk of bleeding. These complications have a significant impact on patient morbidity and mortality. Thus, determining an optimal approach to thromboembolic disease prophylaxis can be challenging.
Case reports: This paper presents two cases of polymorbid female patients suffering from COVID-19. Both patients experienced retroperitoneal hemorrhage while on low molecular weight heparins in the process of deintensification of the treatment of their moderate to severe disease. Although both patients were treated surgically with a good local effect on the hemorrhage, their deterioration progressed, finally resulting in death in both the cases.
Conclusion: Despite the proven benefit of prophylaxis of thromboembolic events using low molecular weight heparins in patients with COVID-19, care should be taken to monitor coagulation laboratory parameters in proper time intervals. The risk of a fatal course of bleeding complications is extremely high in critically ill patients and patients with multiple comorbidities.
Keywords:
coagulopathy – SARS-CoV-2 – COVID-19 – retroperitoneal hemorrhage
Sources
1. Carfora V, Spiniello G, Ricciolino R, et al. Anticoagulant treatment in COVID-19: a narrative review. J Thromb Thrombolysis 2021 Apr;51(3):642–648. doi: 10.1007/ s11239-020-02242-0.
2. Di Minno A, Ambrosino P, Calcaterra I, et al. COVID-19 and venous thromboembolism: A meta-analysis of literature studies. Semin Thromb Hemost. 2020 Oct;46(7):763– 771. doi:10.1055/s-0040-1715456.
3. Stefan M, Chrdle A, Husa P, et al. COVID-19: diagnosis and treatment. Klin Mikrobiol Infekc Lek. 2021 Jun;27(2):61−87.
4. Cui S, Chen S, Li X, et al. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020 Jun;18(6):1421– 1424. doi:10.1111/jth.14830.
5. Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020 May;18(5):1094– 1099. doi:10.1111/jth.14817.
6. Javid A, Kazemi R, Dehghani M, et al. Catastrophic retroperitoneal hemorrhage in COVID-19 patients under antikoagulant prophylaxis. Urology case reports. 2021 May;36:101568. doi:10.1016/j. eucr.2021.101568.
7. Patel I, Akoluk A, Douedi S, et al. Life-threatening psoas hematoma due to retroperitoneal hemorrhage in a COVID-19 patient on enoxaparin treated with arterial embolization: A Case Report 2020;12:458–461. doi:10.14740/ jocmr4256.
8. Scialpi M, Russo P, Piane E, et al. First case of retroperitoneal hematoma in COVID-19. Turkish Journal of Urology 2020;46:407– 409. doi:10.5152/tud.2020.20302.
9. Iba T, Levy JH, Levi M, et al. Coagulopathy in COVID-19. J Thromb Haemost. 2020 Sep;18(9):2103–2109. doi:10.1111/ jth.14975.
10. Thachil J. Theversatile heparin in COVID-19. J Thromb Haemost. 2020 May;18(5):1020–1022. doi:10.1111/ jth.14821.
11. Kow CS, Hasan SS. Use oflow-molecular- weight heparin in COVID-19 patients. J Vasc Surg Venous Lymphat Disord 2020 Sep;8(5):900−901. 2020;8:900–901. doi:10.1016/j.jvsv.2020.06.006.
12. Nahum J, Morichau-Beauchant T, Daviaud F, et al. Venous thrombosis among critically Ill patients with coronavirus disease 2019 (COVID-19). JAMA Netw open 2020 May;3(5):e2010478. doi:10.1001/ jamanetworkopen.2020.10478.
13. Llitjos J-F, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020 Jul;18(7):1743–1746. doi:10.1111/ jth.14869.
14. Erdinc B, Raina JS. Spontaneous retroperitoneal bleed coincided with massive acute deep vein thrombosis as initial presentationof COVID-19. Cureus 2020;12:e9772. doi:10.7759/ cureus.9772.
15. Elsoukkary SS, Mostyka M, Dillard A, et al. Autopsy findings in 32 patients with COVID-19: A single-institution experience. Pathobiology 2021;88(1):56–68. doi:10.1159/000511325.
16. Cao J, Li S, Ma Y, et al. Risk factors associated with deep venous thrombosis in patients with different bed-rest durations: A multi-institutional case-control study. Int J Nurs Stud. 2021 Feb;114:103825. doi:10.1016/j.ijnurstu.2020.103825.
17. Ruskin KJ. Deep vein thrombosis and venous thromboembolism in trauma. Curr Opin Anaesthesiol. 2018 Apr;31(2):215–218. doi:10.1097/ ACO.0000000000000567.
18. Porfidia A, Pola R. Venous thromboembolism in COVID-19 patients. JTH 2020;18:1516–1517. doi:10.1111/ jth.14842.
19. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonaryembolism. Blood Adv. 2020 Oct;4(19):4693– 4738. doi:10.1182/bloodadvances. 2020001830.
20. Musoke N, Lo KB, Albano J, et al. Anticoagulation and bleeding risk in patients with COVID-19. Thromb Res. 2020 Dec;196:227–230. doi:10.1016/j.thromres. 2020.08.035.
21. Nadkarni GN, Lala A, Bagiella E, et al. Anticoagulation, bleeding, mortality, and pathology in hospitalized patients with COVID-19. J Am Coll Cardiol. 2020 Oct;76(16):1815–1826. doi:10.1016/j. jacc.2020.08.041.
22. Mahboubi-Fooladi Z, Pourkarim Arabi K, Khazaei M, et al. Parenteral anticoagulation and retroperitoneal hemorrhage in COVID-19: case report of five patients. SN Compr Clin Med. 2021 Jun:1–6. doi:10.1007/s42399-021-01006-y. Epub akad of print.
23. Lucatelli P, Rocco B, Nardis PG, et al. Bleeding in COVID patients: What we have underwood so far. Cardiovasc Intervent Radiol. 2021 Apr;44(4):666−668. doi:10.1007/s00270-021-02775-8.
24. Yeoh WC, Lee KT, Zainul NH, et al. Spontaneous retroperitoneal hematoma: a rare bleeding occurrence in COVID-19. Oxf Med Case Reports 2021 Sep 13;2021(9):omab081. doi:10.1093/omcr/ omab081.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 12
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