Table 1. Cases of splenic infarction seen in those with COVID-19.
F: female; sq: subcutaneous; TID: three times a day; LMWH: low-molecular-weight heparin; PFO: patent foramen ovale; M: male; HTN: hypertension; BID: twice a day; PE: pulmonary embolism; OSA: obstructive sleep apnea; IgG: immunoglobulin G; LDH: lactate dehydrogenase; GI: gastrointestinal; DM: diabetes mellitus; CKD: chronic kidney disease; CAD: coronary artery disease; HLD: hyperlipidemia; IV: intravenous; CRP: C-reactive protein; ACS: acute coronary syndrome
| Study | Patient | Comorbidities | Symptoms | Complications | Labs | Treatment | Outcome |
| Mahmood et al. 2021 [2] | 27, F | None | Abdominal pain | Possible splenic hemorrhage | D-dimer peak at >20 µg/mL | Prophylactic heparin 5,000 U sq TID daily transitioned to LMWH | Discharged on apixaban |
| de Roquetaillade et al. 2021 [5] | Three patients | Not reported besides 1 with PFO | Not reported | Not reported | Not reported | Not reported | Not reported |
| Dennison et al. 2021 [7] | 70, M | HTN | Left lower quadrant abdominal pain | Bilateral rectus sheath hematomas, mesenteric vessel microhemorrhage | D-dimer 3.90 mg/mL | Prophylactic enoxaparin transitioned to LMWH 80 mg BID | Discharged |
| Santos et al. 2020 [11] | 67, M | HTN | Asymptomatic | Pulmonary PE | Not reported | Not reported | Not reported |
| 53, F | None | Asymptomatic | None | Not reported | Not reported | Not reported | |
| Qasim et al. 2020 [12] | 60s, M | Asthma, OSA, morbid obesity, HTN, IgG deficiency | Dull left-sided abdominal pain | None | D dimer 1,088 ng/mL, ferritin 3,038 ng/mL | Prophylactic enoxaparin 40 mg BID transitioned to heparin drip for 24 hours, followed by enoxaparin 1 mg/kg BID | Discharged on rivaroxaban |
| Ramanathan et al. 2021 [13] | 54, M | Obese | Sharp abdominal pain, nausea, vomiting | Kidney infarction | D-dimer 1.55 µg/mL, ferritin 1,633 ng/mL, LDH 2,136 U/L | Heparin drip at 18 U/kg/hour | Discharged on apixaban |
| Imoto et al. 2021 [14] | 54, M | Not reported | Asymptomatic within GI | Multiple cerebral infarcts, bilateral renal infarcts | Not reported | Lovenox | Expired |
| Besutti et al. 2020 [15] | 53, M | HTN, previous mitral valve replacement | Severe left flank pain | Left kidney infarct | Not reported | LWWH 6,000 U BID for 2 days | Discharged |
| 72, M | HTN, DM type 2, CKD stage 3, CAD | Severe abdominal pain | Small bowel ischemia | D-dimer 6,910 ng/mL | LMWH 4,000 U/day along with acetylsalicylic acid, resection of ischemic bowel, splenectomy, transitioned to heparin drip | Not reported | |
| Sztajnbok et al. 2021 [16] | 60, F | None | Asymptomatic | Aortic thrombosis of descending aorta | D-dimer 4,057 ng/mL, ferritin 719 ng/mL | Prophylactic LMWH 60 mg/day, transitioned to LMWH 60 mg BID | Discharged on warfarin |
| Hossri et al. 2020 [17] | 29, F | Sickle cell disease | Abdominal pain, vomiting | Ischemic stroke | D-dimer 2,822 ng/mL, ferritin 4,511 ng/mL | Heparin drip | Not reported |
| Karki et al. 2020 [18] | 32, M | None | Severe periumbilical pain | Splenic laceration with hemoperitoneum | Not reported | Supportive care | Not reported |
| Bradley et al. 2021 [19] | 76, F | HLD | Not reported | Subarachnoid hemorrhages, pulmonary thrombus, myocarditis | Not reported | Not reported | Expired |
| Tranca et al. 2021 [20] | 31, F | None | Mild dull abdominal pain | Not reported | Not reported | Enoxaparin 1 mg/kg BID, aspirin | Not reported |
| Rigual et al. 2021 [21] | 53, M | Not reported | Not reported | Ischemic stroke, hemorrhagic splenic infarct, bilateral renal infarction, splenic pseudoaneurysm | Not reported | IV thrombolysis and mechanical thrombectomy, followed by enoxaparin 1 mg/kg daily, acetylsalicylic acid 100 mg | Discharged on acetylsalicylic acid |
| Ghalib et al. 2021 [22] | 67, F | HTN, DM, CAD, asthma | Asymptomatic | None | D-dimer 1,072 ng/mL, ferritin 536 ug/L, CRP 163.3 mg/L | Therapeutic heparin infusion | Discharged on LMWH |
| Vidali et al. 2021 [23] | 70, F | Not reported | Left upper quadrant pain | Thrombosis of extrahepatic and intrahepatic portal branches, thrombosis of splenic and mesenteric veins | CRP 10.8 mg/dL, LDH 248 U/L, D-dimer 4,926 ng/mL | LMWH 8,000 U | Not reported |
| Moradi et al. 2021 [24] | 59, F | DM, HTN, HLD | Left upper quadrant pain, left flank pain | Limb ischemia | Normal D-dimer | Heparin drip | Discharged on rivaroxaban, aspirin, clopidogrel |
| Ceci et al. 2021 [25] | 47, M | HLD, DM | Acute abdominal pain | ACS, myocarditis, kidney infarction | Not reported | Aspirin, clopidogrel, enoxaparin 1 mg/kg BID, then transitioned to unfractionated heparin drip; transitioned to warfarin; transitioned to enoxaparin 1 mg/kg BID | Discharged on warfarin |
| Abdelmohsen et al. 2021 [26] | Three patients | Not reported | Not reported | One had small bowel infarcts | Not reported | Not reported | Not reported |
| Mavraganis et al. 2022 [27] | 64, M | None | Severe abdominal pain | Renal thrombosis, splenic vein thrombosis, thoracic aorta thrombi, renal infarct | LDH 1,244 U/L, D-dimer 3.7 mg/L, CRP 1.7 mg/dL | LMWH 6,000 U daily, then transitioned to enoxaparin 8,000 U BID with acetylsalicylic acid 80 mg daily, transitioned to fondaparinux sq 7.5 mg | Discharged on acetylsalicylic acid 80 mg and fondaparinux 7.5 mg sq |
| Berrichi et al. 2021 [28] | 45, M | None | Acute abdominal pain in the left upper quadrant | Acute limb ischemia, renal infarcts, thrombosis of splenic vein | Not reported | IV unfractionated heparin 80 U/kg, thrombectomy, followed by unfractionated heparin drip at 18 U/kg/hour | Discharged |
| Javaid et al. 2022 [29] | 44, M | HTN, obesity | Severe abdominal pain | None | Not reported | Supportive | Discharged |
| Rea et al. 2021 [30] | Three patients | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
| Guillet et al. 2020 [31] | 57, M | DM, obesity | Not reported | Mesenteric thrombi, renal infarction, lower limbs ischemia | D-dimer 1,169 µg/L, CRP 139 mg/L | Prophylactic LMWH transitioned to low-dose acetylsalicylic acid and IV unfractionated heparin | Discharged on warfarin |