Multisite spontaneous hematomas and bleeding in critically ill Chinese patients with COVID-19: two case reports and a literature review.

Multisite spontaneous hematomas and bleeding in critically ill Chinese patients with COVID-19: two case reports and a literature review.

Publication date: Jan 18, 2024

Anticoagulation is recommended as a standardized therapy for COVID-19 patients according to the WHO guidelines. However, bleeding events have also been reported. Hemorrhage or hematoma was observed in sites including the retroperitoneum, brain, alimentary tract, muscles, and soft tissues. Reduction or suspension of anticoagulants is a common intervention. Transfusion, endoscopic hemostasis, and vascular interventional therapy have been used to improve the condition. In this article, we present two cases of concurrent multisite hematomas and bleeding at other sites in patients with SARS-CoV-2 infection. Both patients were treated with heparins and experienced bleeding after the anticoagulation therapy. Both patients were older with more than two comorbidities, and critical COVID-19. Laboratory tests revealed a considerable decrease in hemoglobin levels and alterations in the coagulation system. In the first patient, the main intervention was embolization using angiography. However, we only adjusted the anticoagulation strategy in the second case. The first patient recovered and was discharged; however, the second died of other causes. This study provides a retrospective review of typical hemorrhagic cases during anticoagulation in COVID-19 patients over the course of four years. A relatively comprehensive search was performed in Pubmed by constructing MeSH subject terms on limiting the search period and specific contents. It summarizes and synthesizes the research related to heparins and other novel anticoagulants in the context of COVID-19 from the onset of the pandemic to the present disseminated phase. This study aimed to offer valuable insights and reference points for developing anticoagulation treatment strategies for patients with COVID-19. Anticoagulation is a crucial treatment option for patients with COVID-19. The difference in anticoagulant effects is related to the severity of COVID-19. Nafamostat can reduce thrombosis in the extracorporeal circuits in critically ill patients with COVID-19. The efficacy and safety of novel anticoagulants require further clinical data. Routine bedside assessments and real-time laboratory monitoring are essential for early identification of bleeding events during anticoagulant therapy and administering intervention.

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Concepts Keywords
Anticoagulation Anticoagulation
Chinese Case report
Covid COVID-19
Hemorrhagic Hemorrhage
Retrospective Heparins
Multisite hematomas

Semantics

Type Source Name
disease MESH hematomas
disease MESH bleeding
disease MESH critically ill
disease MESH COVID-19
disease IDO intervention
pathway REACTOME Hemostasis
disease MESH causes
drug DRUGBANK Nafamostat
disease MESH thrombosis
disease VO time
disease MESH Infectious Diseases
drug DRUGBANK (S)-Des-Me-Ampa
drug DRUGBANK Coenzyme M
disease MESH abnormalities
disease MESH cytokine storms
disease VO effective
disease IDO history
disease MESH hypertension
disease MESH diabetic nephropathy
disease MESH coronary disease
disease VO vaccine
disease MESH complications
disease VO laboratory test
disease MESH acute renal injury
disease IDO blood
disease VO dose
drug DRUGBANK Heparin
drug DRUGBANK Norepinephrine
disease MESH shock
disease VO Imovax ID
disease MESH renal insufficiency
drug DRUGBANK Nadroparin
drug DRUGBANK Calcium
disease VO volume
disease MESH chronic renal insufficiency
disease MESH atrial fibrillation
drug DRUGBANK Warfarin
disease IDO process
disease VO vaccination
disease VO vaccinated
disease IDO cell
disease MESH death
disease MESH pulmonary injury
disease MESH pathological processes
disease MESH thrombocytopenia
disease MESH sepsis
disease IDO assay
drug DRUGBANK Enoxaparin
disease MESH Ischemic Heart Disease
disease MESH Diabetes Mellitus
disease MESH disseminated intravascular coagulation
disease VO viable
drug DRUGBANK Trestolone
disease MESH chronic conditions
disease VO report
drug DRUGBANK Guanosine
disease VO company
disease MESH venous Thromboembolism
disease MESH Coronavirus infection
drug DRUGBANK Carboxyamidotriazole
disease MESH deep venous thrombosis
disease VO effectiveness
disease MESH Vascular Diseases
disease MESH Intracranial hemorrhage
drug DRUGBANK Apomorphine
disease MESH viral infection
disease MESH pneumonia
drug DRUGBANK Oxygen

Original Article

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