Evrev D, Sekulovski M, Gulinac M, Dobrev H, Velikova T, Hadjidekov G. Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients: Case series and brief literature review. World J Clin Cases 2023; 11(7): 1528-1548 [PMID: 36926396 DOI: 10.12998/wjcc.v11.i7.1528]
Corresponding Author of This Article
Tsvetelina Velikova, MD, PhD, Academic Editor, Assistant Professor, Medical Faculty, Sofia University St. Kliment Ohridski, Kozyak 1 str., Sofia 1407, Bulgaria. tsvelikova@medfac.mu-sofia.bg
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Delian Evrev, Hristo Dobrev, Department of Cardiac Surgery, University Hospital Lozenetz, Sofia 1407, Bulgaria
Delian Evrev, Metodija Sekulovski, Tsvetelina Velikova, George Hadjidekov, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Metodija Sekulovski, Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
Milena Gulinac, Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 6000, Bulgaria
George Hadjidekov, Department of Radiology, University Hospital “Lozenetz”, Kozyak 1 str., Sofia 1407, Bulgaria
Author contributions: Evrev D, Velikova T, and Hadjidekov G conceptualized the study; Evrev D, Sekulovski M, Gulinac M, Dobrev H and Hadjidekov G performed the investigation; Evrev D, Sekulovski M, Gulinac M, Dobrev H and Hadjidekov G provided resources; Evrev D, Sekulovski M, Dobrev H and Hadjidekov G performed the data curation; Evrev D, Dobrev H and Hadjidekov G participated in the data visualization; Evrev D, Sekulovski M, Gulinac M, and Hadjidekov G wrote the original manuscript draft; Velikova T and Hadjidekov G contributed to the writing and reviewed and edited the final manuscript; Velikova T provided study supervision; All authors revised and approved the final version of the manuscript prior to submission.
Informed consent statement: All patients signed informed consent, and the study was conducted following the Declaration of Helsinki and the Ethics norm of the University Hospital "Lozenetz".
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsvetelina Velikova, MD, PhD, Academic Editor, Assistant Professor, Medical Faculty, Sofia University St. Kliment Ohridski, Kozyak 1 str., Sofia 1407, Bulgaria. tsvelikova@medfac.mu-sofia.bg
Received: October 10, 2022 Peer-review started: October 10, 2022 First decision: November 18, 2022 Revised: December 17, 2022 Accepted: February 10, 2023 Article in press: February 10, 2023 Published online: March 6, 2023 Processing time: 143 Days and 0.9 Hours
Abstract
BACKGROUND
Hospitalized and severely ill coronavirus disease 2019 (COVID-19) patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites. Life-threatening bleeding complications include spontaneous iliopsoas hematoma, peritoneal bleeding, and extra-abdominal manifestations such as intracranial hemorrhage.
CASE SUMMARY
Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding. In our case series of 9 patients, we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia. Contrast-enhanced computed tomography (CE-CT) is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach, whether interventional, surgical, or conservative management.
CONCLUSION
We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling. Finally, we provide a brief review of the literature.
Core Tip: Hospitalized patients with coronavirus disease 2019 (COVID-19) possess a higher risk for both hypercoagulable state and thrombotic complications due to an imbalance in platelet production and destruction and coagulation system disorders that accompany the pathophysiology of this disease. In line with this, the indication of performing contrast-enhanced multidetector computed tomography may help to identify active hemorrhage as a complication of anticoagulant therapy in hospitalized patients with COVID-19 pneumonia. In addition, pre-contrast scans may define the size and the precise location of suspected hematoma, especially when ultrasound findings are inconclusive.
