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Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed?
Pascale Riu1, Fabrizio Albarello2, Federica Di Stefano2
1Interventional Radiologist Unit, Azienda Ospedaliera San Camillo Forlanini, 00149 Rome, Italy.
Journal of Clinical Medicine
|September 28, 2021
Summary
Percutaneous transcatheter arterial embolization (PTAE) aids bleeding COVID-19 patients. PTAE combined with medical therapy improved survival in critically ill patients with spontaneous bleeding.
Area of Science:
- Interventional Radiology
- Critical Care Medicine
- Infectious Diseases
Background:
- Critically ill COVID-19 patients exhibit hypercoagulability, increasing thrombotic risk.
- Anticoagulant therapy, while standard, can lead to severe spontaneous bleeding (SB).
- Percutaneous transcatheter arterial embolization (PTAE) offers a life-saving intervention for bleeding in critical COVID-19 patients.
Purpose of the Study:
- To report the experience of a major Italian Research Hospital regarding PTAE in COVID-19 patients with spontaneous bleeding.
- To analyze the indications and techniques for embolization in this patient population.
- To evaluate the effectiveness of PTAE in managing severe bleeding in COVID-19.
Main Methods:
- Retrospective analysis of SARS-CoV-2 infected patients with spontaneous bleeding over one year.
- Comparison of two groups: PTAE plus medical therapy versus medical therapy alone.
- Collection of computed tomography (CT) scan findings, clinical conditions, and biological data.
Main Results:
- Soft tissue spontaneous bleeding occurred in 1.95% (21/1075) of patients.
- Ten patients treated with PTAE and medical therapy showed a 30-day survival rate of 70%.
- CT findings such as arterial blush, contrast enhancement, and dimensions were significant predictors for embolization (p < 0.05).
Conclusions:
- PTAE is a crucial intervention for severely ill COVID-19 patients experiencing bleeding.
- The decision to perform PTAE requires careful consideration of the patient's clinical and biological status, as well as hematoma characteristics.
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