Abstract
Due to the respiratory infection of SARS-CoV-2, COVID-19 pandemic has now become a global threat. The thrombotic complications are common in COVID-19 patients which have been extensively addressed in various studies. The hemorrhagic complications, however, have received less attention. In this article, 4 cases of COVID-19 patients with hemorrhagic complications are presented. All 4 patients were hospitalized in ICU and received routine COVID-19 treatments such as heparin prophylaxis. During hospitalization, all four patients had rectus sheath hematoma and retroperitoneal hemorrhage. For controlling which, they underwent embolization. Embolization of the inferior epigastric artery and the anterior trunk of internal iliac artery was carried out under fluoroscopy-guided angiography. The active hemorrhage of the patients was controlled. Three patients recovered after the treatment and were discharged while one patient, unfortunately, died due to the severity of the pulmonary involvement, old age, and hemorrhage. First, the hemorrhage of these patients was considered to be the result of the hemorrhagic complications due to the use of heparin. But the hemorrhage volume was not justifiable with the symptoms and complications of prophylaxis dosage of heparin. The attention was gradually drawn to the coagulopathy of the COVID-19 patients. Further investigations are required to clarify the role of effective factors and complications of coagulopathy in patients with COVID-19 and their appropriate treatment. Copyright © 2021, This is an original open-access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation.
Highlights
Due to the respiratory infection of SARS-CoV-2, COVID-19 pandemic has become a global threat (1-4)
The incidence of thrombotic complications such as Pulmonary Thromboembolism, deep vein thrombosis, ischemic stroke, cardiac infarction, and arterial embolism is high in COVID-19 patients which has been reported in numerous studies before (6, 7)
The current study presents four COVID-19 patients with hemorrhagic complications and describes their treatments
Summary
Due to the respiratory infection of SARS-CoV-2, COVID-19 pandemic has become a global threat (1-4). Numerous papers have addressed the pulmonary symptoms of this disease which highly contributed to the identification of the pathogenesis of COVID-19 infection. It seems that ACE2 receptors are involved in the entrance of the virus into the cells. All four patients had positive PCR tests for COVID19 and exhibited bilateral pulmonary involvement with typical COVID-19 pattern (CORADS=6) These patients were admitted in the ICU and received routine COVID-19 treatments. Further investigations showed rectus sheath hematoma and accumulation of loculated fluid in the retroperitoneum (Figure 1) In these patients, due to hemorrhage in the rectus sheath and retroperitoneum, surgical treatment was not the choice and endovascular treatment was selected. Further investigations indicated declined hemoglobin followed by hemorrhage in the rectus sheath and retroperitoneum who received arterial embolization. One patient died due to the severity of pulmonary involvement caused by COVID- 19 due to her advanced age and volume of hemorrhage
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