Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients: Case series and brief literature review

Table 1 Case characteristics from the current case series

Characteristic	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6
Age in yr	63	51	74	86	80	92
Sex	Female	Female	Male	Female	Female	Female
Comorbidities	AH, Asthma	AH, renal transplant, CKD, history of abdominal tumor surgery	AH, IHD, Tonsil carcinoma (status post radiation)	AH, COPD, CKD	AH, ischemic stroke	AH
Chronic anticoagulant/antiplatelet use	ASA	No	No	ASA	ASA	ASA
Clinical presentationat admission	Fever, asthenia, myalgia	Asthenia, dyspnea, cough	Fever, asthenia, loss ofappetite	Fever, asthenia, dyspnea	Fever, asthenia, diarrhea	Fever, asthenia, dyspnea, cough
Duration of illness before admission in days	5	20	11	7	7	7
SpO2 at admission, %	92	94	94	78	87	97
Time from admission to bleeding in days	9	2	5	10	10	6
Type of bleed	Intraperitoneal	RSH, Extra-peritoneal	SRH	RSH	SRH	RSH
Signs and symptoms of bleed	Abdominal pain	Leg edema, asthenia, low hemoglobin	Abdominal pain	Abdominal pain, hypotension, abdominal guarding	Abdominal Pain (lateral)	Low hemoglobin, abdominal swelling
Hemodynamic instability	No	No	No	Yes	No	No
Maximum O2 therapy prior to bleed	15 L, mask	3-4 L, mask	9 L, mask	4 L, mask	7 L, nasal	OTI
Pulmonary changes	Moderate	Severe	Mild	Mild	Moderate	Moderate
Length of hospitalization (days)	20	15	20	11	25	10
Anticoagulation (prophylactic)	LMWH 4000 IU, BID	No	LMWH 4000 IU, BID	LMWH 4000 IU, BID	No	LMWH 4000 IU, BID
Anticoagulation (therapeutic)	No	LMWH 4000 IU, BID	No	No	LMWH 6000 IU, BID	No
Antiplatelet therapy	ASA	No	ASA	ASA	No	No
Steroids	Methyl-prednisolone	Methyl-prednisolone	Dexa-methasone	Methyl-prednisolone	Methyl-prednisolone	Methyl-prednisolone
Bioproduct units (pRBC/FFP)	2/3	4/4	3/2	2/2	No	No
Surgery	No	Yes	No	No	Yes	No
Outcome	Discharged	Discharged	Discharged	Died	Discharged	Died

AH: Arterial hypertension; IHD: Ischemic heart disease; AF: Atrial fibrillation; CKD: Chronic kidney disease; COPD: Chronic obstructive pulmonary disease; PE: Pulmonary embolism; PM: Pacemaker; ASA: Acetylsalicylic acid; RSH: Rectus sheath hematoma; SRH: Spontaneous retroperitoneal hematoma; OTI: Orotracheal intubation; CPAP: Continuous positive airway pressure; LMWH: Low molecular weight heparin; IU: International unit; BID: Twice daily; pRBC: Packed red blood cells; FFP: Fresh frozen plasma.