A Case Series of Life-Threatening Hemorrhagic Events in Patients with COVID-19

Area of Science:

• Internal Medicine
• Hematology
• Infectious Diseases

Background:

• COVID-19 syndrome is associated with a thrombo-inflammatory cascade, leading to venous microthrombotic and thromboembolic events.
• Anticoagulant therapy is recommended for COVID-19 patients, but consensus on type, dosage, and duration is lacking.
• Patients with COVID-19 may be vulnerable to hemorrhagic events when administered anticoagulants.

Purpose of the Study:

• To present a series of seven SARS-CoV-2 confirmed cases experiencing bleeding complications after initiating anticoagulation.
• To investigate the clinical presentation, surgical management, and autopsy findings in these patients.

Main Methods:

• Retrospective case series of seven COVID-19 patients with bleeding complications.
• Review of medical records, surgical interventions, and autopsy findings.
• Analysis of anticoagulant protocols and patient outcomes.

Main Results:

• All seven patients developed bleeding complications, most commonly rectus sheath hematoma extending to pelvic/retroperitoneal spaces and bowel mesentery.
• Despite surgical care, all seven patients died.
• Autopsy studies ruled out disseminated intravascular coagulation (DIC)/sepsis-induced coagulopathy (SIC) or organ failure as the cause of death, confirming pulmonary SARS-CoV-2 involvement and bleeding.

Conclusions:

• The nature of COVID-19 syndrome increases patient vulnerability to hemorrhagic events following anticoagulant administration.
• Anticoagulation in COVID-19 patients carries a significant risk of potentially fatal bleeding complications.
• Further research is needed to optimize anticoagulant strategies in COVID-19 to mitigate bleeding risks.