Spontaneous retroperitoneal bleeding in COVID-19 patients - two case reports
Summary
Low molecular weight heparin prophylaxis for COVID-19 patients carries bleeding risks. Careful monitoring of coagulation is crucial, especially in critically ill patients with comorbidities, to prevent fatal hemorrhage.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Hematology
Background:
- COVID-19 is linked to high thromboembolic event risk, particularly in severe cases.
- Thromboembolic complications significantly increase patient morbidity and mortality.
- Balancing prophylactic anticoagulation with bleeding risk in COVID-19 is challenging.
Observation:
- Two polymorbid female COVID-19 patients developed retroperitoneal hemorrhage during low molecular weight heparin (LMWH) treatment.
- Hemorrhage occurred during de-escalation of LMWH for moderate to severe COVID-19.
- Surgical intervention provided local hemostasis, but patient outcomes deteriorated.
Findings:
- Despite LMWH's benefit in preventing thromboembolic events in COVID-19, bleeding complications can be fatal.
- Close monitoring of coagulation parameters is essential during LMWH therapy.
- Critically ill patients and those with multiple comorbidities face an elevated risk of fatal bleeding.
Implications:
- This case series highlights the critical need for vigilant coagulation monitoring in COVID-19 patients receiving LMWH.
- Optimal anticoagulation strategies must carefully weigh the benefits of thromboembolic prophylaxis against the risk of severe bleeding.
- Further research into tailored anticoagulation protocols for high-risk COVID-19 patients is warranted.
