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Spontaneous bleeding in COVID-19: A retrospective experience of an Italian COVID-19 hospital
Mirko Trentadue1, Plinio Calligaro2, Gianluigi Lazzarini3
1Radiology Unit, M. Magalini Hospital, AULSS 9 Scaligera, Villafranca di Verona, Italy.
Insights
Spontaneous haemorrhages occurred in 2.22% of COVID-19 patients, predominantly in critically ill, elderly males with comorbidities. This bleeding complication did not significantly impact patient outcomes in this study.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Hematology
Background:
- Haemorrhages are a known complication in patients with coronavirus disease 2019 (COVID-19).
- Understanding and managing these bleeding events is crucial for patient care.
Purpose of the Study:
- To characterize the occurrence and features of spontaneous haemorrhages in hospitalized COVID-19 patients.
- To investigate correlations between bleeding events and patient demographics, comorbidities, and treatments.
Main Methods:
- Retrospective analysis of CT scans from 1396 hospitalized COVID-19 patients over 13 months.
- Identification of spontaneous bleeding events and analysis of associated patient characteristics.
Main Results:
- Haemorrhages occurred in 2.22% of COVID-19 patients (7.88% in ICU).
- Bleeding was more common in anticoagulated, elderly males (60-79 years) with multiple comorbidities, often in critical condition and on mechanical ventilation.
- Active haematomas were noted in nearly half of cases, with earlier onset in those with multiple morbidities.
Conclusions:
- Knowledge of haemorrhage as a complication is essential for COVID-19 management, with CT imaging vital for diagnosis.
- While anticoagulant use is debated, bleeding complications in this study did not significantly affect patient outcomes.
Background:
Haemorrhages in coronavirus disease 2019 (COVID-19) patients require proper knowledge and management.
Objectives:
To highlight the characteristics of haemorrhages in patients with COVID-19 infection.
Method:
A retrospective study examined CT scans performed over a 13-month period in patients hospitalised with COVID-19 infection to determine those who developed spontaneous bleeding. The authors also investigated correlations between the bleeding events and the patients' characteristics.
Results:
Haemorrhages occurred in 2.22% (31/1396) of patients hospitalised with COVID-19 infection (7.88%, 19/241 in the intensive care unit). Bleeding, major in most cases, occurred in anticoagulated patients, especially males with multiple comorbidities, aged between 60 and 79 years and mainly appeared in a single anatomical region (especially retroperitoneal), with the most voluminous in the chest wall. The complication was diagnosed on average 16.7 days after admission and occurred predominantly in critically ill patients undergoing invasive ventilation and pronation-supination cycles. In just under half of the cases, the haematomas were active, and in these cases, mainly with a single contrast blush and with earlier onset after the start of anticoagulation than in non-active bleeding. Major bleeding was also earlier in the presence of multiple morbidity. The vast majority of patients were treated conservatively and survived.
Conclusion:
At COVID-19 hospital centres, it is advisable that there is knowledge of such a complication for which CT imaging is essential for diagnosis and proper management. Although some authors have expressed doubts about anticoagulant treatment in patients with COVID-19, the bleeding complication in this study did not significantly affect the outcome.
Contribution:
Spontaneous haemorrhage did not significantly affect the outcome in this series.
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