Life-Threatening Spontaneous Hematoma in Unusual Sites in Patients with COVID-19 on Anticoagulant Therapy: A Case Series
Abstract
Thromboembolic manifestations are a common
phenomenon in patients affected by corona virus (SARS
CoV-2). Recent studies have shown that patients with acute
renal failure are also at a greater risk of venous and arterial
thromboembolism, 15-30% in ICU, and 7% inpatient care.
However, frequently unjudicial use of anticoagulants may
develop severe life-threatening hematoma. In our hospital
settings we had a dedicated COVID Unit with a
Hemodialysis facility. Our Nephrology department had
managed 381 patients being COVID positive along with
renal impairment from March 2020 to January 2022.
Among these patients, four patients developed spontaneous
non traumatic hematoma in unusual sites. On admission
all the patients received treatment according to our national
guidelines for COVID-19. Cases: It is a retrospective analysis
in a single-centered hospital. Four cases with confirmed
COVID-19 with acute kidney injury and on anticoagulant
therapy had developed sudden concealed bleeding. These
patients had no previous history of anticoagulant therapy
before admission. Case 1 developed hemorrhage in Right
lower anterior paramedian deep parietal wall of abdomen,
Case 2 had hematoma in retroperitoneal space and in lower
third of Iliopsoas, Case 3 developed hemorrhage in left
cerebral hemisphere, Case 4 had Intramuscular Hematoma
in left rectus abdominis. Out of these four patients two of
them required Hemodialysis and one of them went into
shock. All patients included were male. The mean age was
57±19.64years. All the four patients were initially managed
conservatively with keen monitoring and with proper volume
resuscitation, blood transfusion and discontinuation of
the anticoagulants. Three of the patients survived with
conservative management and one patient died due to
sudden massive cardiac arrest. The use of therapeutic
anticoagulant can increase the risk of bleeding in atypical
sites and may exhibit higher patient death with COVID-19
if not identified at early stage. So a risk-benefit ratio of
usage of anticoagulants should be kept in mind and further
clinical trials needed to justify its random use in COVID-19.