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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
An 84-year-old man developed thrombocytopenia, bleeding and atypical spontaneous haematomas during treatment with aspirin and enoxaparin sodium [routes not stated].
The man, who had hypertension, chronic obstructive pulmonary disease and ischaemic heart disease, presented on 28 March 2020 with chills and shortness of breath for 10 days. Following investigations, he was diagnosed with COVID-19. His medications included aspirin [acetylsalicylic acid] 100mg once daily, vilanterol/fluticasone furoate [fluticasone furoate/vilanterol], pantoprazole and simvastatin. Additionally, he started receiving off label treatment with piperacillin/tazobactam 4.5g every 8 hours and hydroxychloroquine 200mg twice daily. On 30 March 2020, he started receiving enoxaparin sodium [enoxaparin] 40mg once daily. On 02 April 2020, he developed mild thrombocytopenia with platelet count 70 x 109/L.
Enoxaparin sodium was stopped on 03 April 2020. Due to worsening of respiratory failure, he required support of continuous positive airway pressure. On 08 April 2020, early morning, a bilateral neck and upper chest subcutaneous haematoma were noted with mild pain and swelling. A contrast CT scan of the neck and chest revealed bleeding and asymmetric, bilateral haematoma (left> right) of the sternocleidomastoid muscles. After a few hours, he reported worsening pain in the left inguinal region, and a deep muscular haematoma within adductors muscle was noted. His lab values revealed oxygen saturation of haemoglobin 96%, haemoglobin 14.3 g/L, platelet count 126 x 109/L, WBC 5.81 x 109/L and CRP 16.0 mg/L. Aspirin was stopped on 08 April 2020. Subsequently, the thrombocytopenia resolved. On 12 April 2020, moderate anaemia was noted with haemoglobin 9.2 g/L and platelet count 168 x 109/L. On 14 April 2020, red packed cells were transfused. Haemoglobin was monitored daily with bedside colour doppler ultrasonography, and it remained stable. On 17 April 2020, 9 days after bleeding onset, he was discharged following recovery of the atypical spontaneous haematomas. Follow up after 30 day of discharge was without recurrence with stable haemoglobin.
Reference
- Mattioli M, et al. Atypical Spontaneous Hematomas in a Patient with Severe Coronavirus Disease 2019 (COVID-19). Seminars in Thrombosis and Hemostasis 46: 856-858, No. 7, Oct 2020. Available from: URL: 10.1055/s-0040-1715092 [DOI] [PMC free article] [PubMed]