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2020 ; 12
(7
): 458-461
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gab.com Text
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Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19
Patient on Enoxaparin Treated With Arterial Embolization: A Case Report
#MMPMID32655742
Patel I
; Akoluk A
; Douedi S
; Upadhyaya V
; Mazahir U
; Costanzo E
; Flynn D
J Clin Med Res
2020[Jul]; 12
(7
): 458-461
PMID32655742
show ga
Respiratory failure is presumptively caused by microvascular thrombosis in some
patients with coronavirus disease 2019 (COVID-19) requiring therapeutic
anticoagulation. Anticoagulation treatment may cause life-threatening bleeding
complications such as retroperitoneal hemorrhage. To the best of our knowledge,
we report first case of a COVID-19 patient treated with therapeutic
anticoagulation resulting in psoas hematoma due to lumbar artery bleeding. A
69-year-old patient presented with fever, malaise and progressive shortness of
breath to our hospital. He was diagnosed with COVID-19 by RT-PCR. Due to an
abnormal coagulation profile, the patient was started on enoxaparin. Over the
course of hospitalization, the patient was found to have hypotension with
worsening hemoglobin levels. Computed tomography scan of the abdomen and pelvis
revealed a large psoas hematoma. Arteriogram revealed lumbar artery bleeding
which was treated with embolization. Anticoagulation therapy, while indicated in
COVID-19 patients, has its own challenges and guidelines describing dosages and
indications in this disease are lacking. Rare bleeding complications such as
psoas hematoma should be kept in mind in patients who become hemodynamically
unstable, warranting prompt imaging for diagnosis and treatment with arterial
embolization, thus eliminating need of surgical intervention.