Coagulopathy in COVID-19 Patients and Endovascular Treatment, Reports of 4 Patients
Coagulopathy in COVID-19 Patients and Endovascular Treatment, Reports of 4 Patients
Erfan Mohammadi-Vajari,1,*Mohammad-Ali Mohammadi-Vajari,2Mohammadreza Babaei,3
1. Student of Medicine, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, I. R. Iran 2. Department of Radiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, I. R. Iran 3. Department of Radiology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
Introduction: Due to the respiratory infection of SARS-CoV-2, COVID-19 pandemic has now become a global threat . Numerous papers have addressed the pulmonary symptoms of this disease which highly contributed to the identification of the pathogenesis of COVID-19 infection. It seems that ACE2 receptors are involved in the entrance of the virus into the cells. Regarding the presence of these receptors on the surface of the alveoli epithelial cells and vascular endothelium, these cells and organs are prone to this virus . The incidence of thrombotic complications such as Pulmonary Thromboembolism, deep vein thrombosis, ischemic stroke, cardiac infarction, and arterial embolism is high in COVID-19 patients which has been reported in numerous studies before . The initial clinical sign of coagulopathy in COVID-19 is organ failure while hemorrhagic complications are less common. The changes in the hemostatic markers such as D-dimer and fibrin and fibrinogen products have indicated that the basis of the coagulopathy is probably the fibrin products . However, the hemorrhagic complications of COVID-19 patients have received less attention. In this context, the current study presents four COVID-19 patients with hemorrhagic complications and describes their treatments.
Methods: In this article, 4 cases of COVID-19 patients with hemorrhagic complications are presented. 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. For controlling which, they underwent embolization. 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.
Results: 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 considered to be the result of 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. Further investigations are required to clarify the role of effective factors and complications of coagulopathy in patients with COVID-19 and their appropriate treatment.
Conclusion: 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 .