Related Experiment Video
Updated: Oct 23, 2025
Massive Pontine Hemorrhage by Dual Injection of Autologous Blood
Published on: May 29, 2021
Spontaneous Muscle Hematoma in Japanese Patients with Severe COVID-19 Treated with Unfractionated Heparin: Two Case
Yu Ito1, Nobuyasu Awano1, Fumiya Uchiyama2
1Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan.
Insights
Severe COVID-19 patients on anticoagulation can develop spontaneous muscle hematomas (SMH). Early diagnosis via contrast-enhanced computed tomography (CECT) is crucial for managing bleeding risks in these patients.
Area of Science:
- Internal Medicine
- Hematology
- Radiology
Background:
- Anticoagulation therapy is standard for hospitalized COVID-19 patients to prevent thrombosis.
- However, anticoagulation increases the risk of bleeding complications.
Observation:
- Two Japanese patients with severe COVID-19 developed spontaneous muscle hematomas (SMH) despite therapeutic unfractionated heparin.
- Hematomas were located in the bilateral iliopsoas muscles and required emergent transcatheter embolization.
Findings:
- Contrast-enhanced computed tomography (CECT) confirmed SMH in both cases, even with activated partial prothrombin time within the optimal range.
- This suggests SMH can occur even when coagulation parameters appear controlled.
Implications:
- Close monitoring of the coagulation system is essential in severe COVID-19 patients receiving anticoagulants.
- Early diagnosis of bleeding complications, such as SMH, using CECT is critical for timely intervention and management.
Abstract:
In hospitalized coronavirus disease 2019 (COVID-19) patients, anticoagulation therapy is administered to prevent thrombosis. However, anticoagulation sometimes causes bleeding complications. We herein report two Japanese cases of severe COVID-19 in which spontaneous muscle hematomas (SMH) developed under therapeutic anticoagulation with unfractionated heparin. Although the activated partial prothrombin time was within the optimal range, contrast-enhanced computed tomography (CECT) revealed SMH in the bilateral iliopsoas muscles in both cases, which required emergent transcatheter embolization. Close monitoring of the coagulation system and the early diagnosis of bleeding complications through CECT are needed in severe COVID-19 patients treated with anticoagulants.
