Extra-cranial hemorrhagic complications in patients with COVID-19 infection: the experience of a secondary care COVID-19 institution

Abstract

BACKGROUND: COVID-19 patients are considered to be at high risk for thromboembolic events, and are subjected to large doses of anticoagulants. However, the associated risk of major bleeding remains underestimated. The aim of this study was to investigate extracranial major bleeding complications in a cohort of critically ill patients with COVID-19 pneumonia, diagnosed with computed tomography (CT) or magnetic resonance (MR), and to examine their relationship with laboratory data and pro-thrombothic status.METHODS: In this retrospective observational study, patients admitted to a single secondary care center from November 1, 2020 and January 31, 2022, who tested positive for COVID-19 and developed significant anemia (reduction in Hb levels >2 g/dL) over the course of hospitalization were included. Clinical-laboratory parameters and imaging were reviewed.RESULTS: Out of 279 patients, hemorrhagic complications were detected in 18 patients (10 males, 8 females, mean age 78.6 years, range 63-89 years), with CT evidence of atraumatic bleedings in the thoraco-abdominal wall (N.=8, bilaterally in one case), in the thoracic cavity (N.=2), in the iliopsoas compartment (N.=5), and in the intestinal lumen (N.=1). Intra-articular (N.=1) and intraspinal (N.=1) hematomas were also found. 14/18 patients underwent angiographic embolization. Three patients simultaneously showed pulmonary embolism.CONCLUSIONS: Spontaneous major extracranial bleeding, at the thoraco-abdominal level and in other atypical sites, represents a rare but serious complication of COVID-19 infection and must always be considered in case of anemia during the course of the disease and relative hospitalization.