Abstract Number: PB0302
Meeting: ISTH 2021 Congress
Background: Low molecular weight heparin (LMWH) is recommended in hospitalized patients with coronavirus disease 2019 (COVID-19) due to high risk of thromboembolism.However, LMWH must be carefully dosed for the bleeding risk related to the hemostatic changes in COVID-9 patients.
Aims: To investigate the correlation between COVID-19 related hemorrhagic alterations and the onset of spontaneous Iliopsoas hematoma (IPH).
Methods: We analyzed data from our patient’s medical records and the reports found in PUBMED.
|Basal Features||Patient 1||Patient 2|
|Age, Sex||75, Male||79, Male|
|Personal History||Chronic obstructive pulmonary disease, carotid atheromatous plaques, ischemic stroke||Hypertension|
|Body mass index||26.4||30.4|
|Iliopsoas Hematoma Features||Bilateral||Monolateral|
|Max Dimension||Right 52.6 mm; Left 40.5 mm||91.6 mm|
|Onset after admission||10 days||14 days|
|Enoxaparin Dosage before onset||6000 I.U. twice daily||6000 I.U. twice daily|
|Enoxaparin Dosage after onset||4000 I.U. twice daily||5000 I.U. twice daily|
|Time until remission||27 days||21 days|
There are currently very few reports about unprovoked IPS in COVID-19 patients: a 69-year-old male, on aspirin, who was started on daily 4000 I.U. LWMH at hospitalization, and who developed severe IPH after 20 days; a 74-year-old man treated with LMWH 4000 IU twice daily (b.i.d.) for atrial fibrillation (AF),with a worsening prolongation of PT and PTT during hospitalization, and a 56-year-old man, on LMWH 4000 b.i.d. for AF, with normal coagulation pattern at the admission, but with a moderately increased PT and a thrombocytopenia during the hospitalization, who developed IPH after 27 days. A bout our experience, we reported two cases (patients’ features summarized in table 1): a 75-year-old male on clopidogrel due to an ischemic stroke, which was substituted by LMWH 4000 I.U. b.i.d. and who had a transient ischemic attack after 7 days: for this reason, the LMWH dosage was increased to 6000 I.U. b.i.d. After ten days he developed IPS: a moderate and transient thrombocytopenia, disappeared spontaneously after some days, was observed without coagulation alterations. The second case was a 79-year-old obese male, who started increased LMWH prophylaxis with enoxaparin 6000 I.U. b.i.d. Two weeks after admission, the patient manifested a spontaneous IPS. No changes were observed in coagulation parameters, nor a reduction in the platelet count.
Conclusions: Differently from other reports, in our experience, IPH in COVID-19 patients cannot be certainly or directly related to depletion of coagulation factors or consuming of platelets. Further studies are needed to assess the hemorrhagic risk of antithrombotic therapy, as well as investigation of virus-related acquired coagulation disorders predisposing to bleeding in COVID-19.
To cite this abstract in AMA style:Sottilotta G, Mangano C, Basile R, Falcone C, Luise F, Megalizzi D, Nicolò GM, Oriana V, Piromalli A. Incidence of Spontaneous Iliopsoas Hematoma in COVID-19 Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/incidence-of-spontaneous-iliopsoas-hematoma-in-covid-19-patients/. Accessed September 24, 2021.
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