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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
A case series, described 4 patients including 2 men and 2 women aged 67−88 years old, who developed chest wall haematoma, left adductor muscle, proximal ham-string muscles, piriformis and gluteus maximus haematoma or thigh haematoma during treatment with enoxaparin-sodium for COVID-19- associated hypercoagulability or clopidogrel for antiplatelet therapy.
Case 1: A 77-year-old woman developed chest wall haematoma during treatment with enoxaparin-sodium for COVID-19- associated hypercoagulability. She was hospitalised following the diagnosis of COVID-19 pneumonia. She started receiving remdesivir and off label therapy with hydroxychloroquine, methylprednisolone and tocilizumab for COVID-19 pneumonia. However, she developed COVID-19- associated hypercoagulability. Therefore, she started receiving SC enoxaparin sodium [enoxaparin] 85mg every 12h on day 7 of admission. But, on day 14 of admission, a CT angiography of the chest revealed left chest wall haematoma. As a result, she underwent transfusion with RBC, fresh frozen plasma and CT-guided drainage of chest wall haematoma. Subsequently, her symptoms resolved and, she was discharged in stable condition.
Case 2: A 88-year-old woman developed chest wall haematoma during treatment with enoxaparin-sodium for COVID-19- associated hypercoagulability. She was hospitalised following the diagnosis of COVID-19 pneumonia. She started receiving off label therapy with doxycycline and ceftriaxone for COVID-19 pneumonia. However, she developed COVID-19- associated hypercoagulability. Therefore, she was initiated on SC enoxaparin sodium [enoxaparin] 60mg twice daily on day 2 of admission. But, on day 5 of admission, a CT angiography of the chest revealed left chest wall haematoma. As a result, she underwent transfusion with packet RBC, fresh frozen plasma and surgical drainage of chest wall haematoma. Subsequently, her symptoms resolved and, she was discharged in stable condition.
Case 3: A 87-year-old man developed left adductor muscle, proximal ham-string muscles, piriformis and gluteus maximus haematoma during treatment with enoxaparin-sodium for COVID-19- associated hypercoagulability. He was hospitalised following the diagnosis of COVID-19 pneumonia. He started receiving off label therapy with hydroxychloroquine for COVID-19 pneumonia. However, he developed COVID-19- associated hypercoagulability. Therefore, he was initiated on SC enoxaparin sodium [enoxaparin] 80mg every 12h on day 3 of admission. But, on day 12 of admission, an abdominal pelvic CT revealed left adductor muscle, proximal ham-string muscles, piriformis and gluteus maximus haematoma. As a result, he underwent transfusion with packet RBC and received supportive care. Subsequently, his symptoms resolved and, he was discharged in stable condition.
Case 4: A 67-year-old man developed thigh haematoma during treatment with enoxaparin-sodium for COVID-19- associated hypercoagulability and clopidogrel for antiplatelet therapy. He was hospitalised following the diagnosis of COVID-19 pneumonia. He started receiving off label therapy with hydroxychloroquine, azithromycin and methylprednisolone for COVID-19 pneumonia. However, he developed COVID-19- associated hypercoagulability. Therefore, he was initiated on SC enoxaparin sodium [enoxaparin] 75mg twice daily on day 3 of admission. He had been also receiving oral clopidogrel 75mg daily for antiplatelet therapy at the time of the bleeding episode. But, on day 14 of admission, a thigh CT revealed anterior compartment of right thigh haematoma, which was attributed to enoxaparin sodium and clopidogrel. As a result, he underwent transfusion with packet RBC and surgical evacuation of haematoma. Subsequently, his symptoms resolved and, he was discharged in stable condition.
Reference
- Singh B, et al. COVID-19 and bleeding at unusual locations: Report of four cases. Hematology, Transfusion and Cell Therapy 43: 214-218, No. 2, Apr-Jun 2021. Available from: URL: 10.1016/j.htct.2021.01.007 [DOI] [PMC free article] [PubMed]