Life-threatening hematomas in COVID-19 patients

BACKGROUND: The COVID-19 pandemic has caused over 1.75 million deaths in the world to date. Although the leading cause of mortality is respiratory disorders and thromboembolic pathologies, other rare pathologies may also increase mortality and morbidity. In our study, we aimed to examine life-threatening hematomas, risk factors, and management during COVID-19.
METHODS: Institutional center (a third level pandemic center) database was searched for patients hospitalized for COVID-19 during 10 months period between March 11, 2020, and December 17, 2020, retrospectively. Patients with bleeding symptoms/signs were de-tected. Patients with gastrointestinal system bleeding were excluded from the study. Patients with hematomas were included in the study.
RESULTS: Eleven of a total 5484 patients had hematomas (0.2%). Median age was 76 (min–max: 56–90). Seven (63.6%) patients were male and 4 (36.4%) were female. All patients had at least one comorbidities, been under treatment dose of low-molecular-weight hep-arin (LMWH) and severe or critical COVID-19 disease. Seven retroperitoneal hematomas, two rectus sheath hematomas, one breast hematoma, and in one patient both retroperitoneal and breast hematomas were diagnosed. Angiographic arterial embolization was applied to 5 (45.5%) patients. Overall mortality rate in patients with bleeding complications was 54.5% (n=6), and the male-to-female ratio was 66.7% (n=4) versus 33.3% (n=2).
CONCLUSION: Hematomas are rare, but mortality increasing phenomena in COVID-19 patients. Age, male gender, severe or critical COVID-19 disease, comorbidities, and treatment dose of LMWH may be risk factors. New onset of abdominal/back pain and ecchymotic skin lesions may be signs of bleeding in this patient group. Mortality can be reduced by early diagnosis of hematoma and interventional methods.

Covid-19 hastalarýnda hayatý tehdit eden hematomlar

AMAÇ: Covid-19 salgýný bugüne kadar dünyada 1.75 milyondan fazla ölüme neden oldu. Mortalitenin önde gelen nedenleri solunum bozukluklarý ve tromboembolik patolojiler olmakla birlikte, diðer nadir patolojiler de mortalite ve morbiditeyi artýrabilir. Çalýþmamýzda Covid-19 hastalarýnda hayatý tehdit eden hematomlarý, risk faktörlerini ve yönetimini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Kurumsal merkez (üçüncü düzey pandemi merkezi) veri tabanýnda, 11 Mart 2020 ve 17 Aralýk 2020 tarihleri arasýndaki 10 aylýk dönemde Covid-19 nedeniyle hastaneye yatýrýlan hastalarýn verileri geriye dönük olarak tarandý. Kanama semptomlarý/bulgularý olan hastalar tespit edildi. Gastrointestinal sistem kanamasý olan hastalar çalýþma dýþý býrakýldý. Hematom tespit edilen hastalar dahil edildi.
BULGULAR: Toplam 5484 hastanýn 11’inde hematom vardý (%0.2). Medyan yaþ 76 idi (min-maks: 56–90). Hastalarýn yedisi (%63.6) erkek, dördü (%36.4) kadýndý. Tüm hastalarýn en az bir komorbiditesi vardý, tüm hastalarýn ciddi veya kritik Covid-19 hastalýðý vardý ve tamamý tedavi dozunda düþük moleküler aðýrlýklý heparin kullanýyordu. Yedi retroperitoneal hematom, iki rektus kýlýf hematomu, bir meme hematomu ve bir hastada meme ve retroperitoneal hematom birlikte saptandý. Beþ (%45.5) hastaya anjiyografik arteriyel embolizasyon uygulandý. Kanama komplikasyonlarý olan hastalarda genel mortalite oraný %54.5 (n=6) ve erkek/kadýn oraný %66.7 (n=4) ve %33.3 (n=2) idi.
TARTIÞMA: Hematomlar nadir, ancak Covid-19 hastalarýnda mortaliteyi artýran fenomenlerdir. Yaþ, erkek cinsiyet, þiddetli veya kritik düzeyde Covid-19 hastalýðý, komorbiditeler, tedavi dozu düþük moleküler aðýrlýklý heparin risk faktörleri olabilir. Yeni baþlayan karýn/sýrt aðrýsý ve ekimotik deri lezyonlarý bu hasta grubunda kanama belirtileri olabilir. Hematomun erken teþhisi ve giriþimsel yöntemlerin kullanýlmasý ile mortalite azaltýlabilir.