COAGULOPATHY IN COVID-19 PATIENTS AND ENDOVASCULAR TREATMENT, REPORTS OF 4 PATIENTS

Coagulopathy In COVID-19 Patients And Endovascular Treatment, Reports Of 4 Patients
Mohammad Ali Mohammadi Vajari*
Department of Radiology, Iran University of Medical Sciences
Mohammad-Reza Babaee
Erfan Mohammadi-Vajari
Background:
COVID-19 pandemic due to the respiratory infection of SARS-Cov-2 has now become a global threat. The thrombotic complications are common in COVID-19 patients which have been extensively addressed in various studies. The hemorrhagic complications, however,  have received less attention. In this article, 4 cases of COVID-19 patients with hemorrhagic complications are presented.
Case Presentation:
All 4 patients were hospitalized in ICU and received routine COVID-19 treatments such as heparin prophylaxis. During hospitalization, all four patients had rectus sheath hematoma and retroperitoneal hemorrhage. They underwent embolization to control hemorrhage. Embolization of the inferior epigastric artery and the anterior trunk of internal iliac artery was carried out under fluoroscopy-guided angiography. The active hemorrhage of the patients was controlled. Three patients recovered after the treatment and were discharged while one patient, unfortunately, died due to the severity of the pulmonary involvement, old age, and hemorrhage. First, the hemorrhage of these patients was assigned to the hemorrhagic complications due to the use of heparin. But the hemorrhage volume was not justifiable with the symptoms and complications of prophylaxis dosage of heparin. The attention was gradually drawn to the coagulopathy of the COVID-19 patients.
Discussion:
There is increasing awareness of coagulation disorders in Covid-19 infection. Thrombotic complications seem to be common among this patient population, which may necessitate preparing appropriate guidelines for its management. However hemorrhagic complications and their proper treatment should also be taken into consideration in Covid-19 infection.