• Silvia Otero-Rodriguez, Cristina Guillen, Maria Mataix, Pilar Gonzalez-de-la-Aleja, Elisabeth Cruces-Fuentes, Alix Juliette Mantilla-Pinilla, Oscar Moreno-Perez, Rosario Sanchez-Martinez, Esperanza Merino, and Jose-Manuel Ramos-Rincon.
• Infectious Diseases Unit, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
• Int. J. Clin. Pract. 2023 Jan 1; 2023: 66684756668475.

ObjectiveTo describe the epidemiological, clinical, laboratory, and radiological characteristics, medical treatment, and outcomes of a case series of severe spontaneous hematoma in COVID-19. Material and Methods. This retrospective study included patients hospitalized for COVID-19 who were diagnosed with severe spontaneous bleeding complications by following a standardized treatment protocol that included computed tomography angiography (CTA) from 1 March 2020 to 28 February 2022. The main outcomes were embolization and all-cause mortality. Baseline variables were analyzed for their association with mortality using bivariable logistic regression, and results were expressed as odds ratios (OR) and 95% confidence intervals (CI).ResultsIn total, 2450 adults were hospitalized for COVID-19 in our center during the study period. 20 patients presented severe and spontaneous intramuscular bleeding (8.1 per 1000 COVID-19 admission vs. 0.47 per 1000 non-COVID-19 admissions, p < 0.001); their median age was 68.5 years (interquartile range (IQR) 63, 80), they had high comorbidity (median Charlson comorbidity index 4.5), and 95% were receiving high doses of heparin. The median interval from COVID-19 symptoms to bleeding was 17 days (IQR 13, 24), and 70% reported cough as a previous symptom. Hypovolemic shock, hypotension, and abdominal pain were the most frequent symptoms of the hematoma. All presented decreased hemoglobin, and 95% required transfusion. Intramuscular hematoma occurred most frequently in the rectus sheath, iliopsoas compartment, and femoral-iliac compartment. All patients underwent embolization; mortality was 45%. We did not identify risk factors associated with an increased risk of death.ConclusionAlthough severe bleeding is an uncommon complication of COVID-19, its prevalence is higher than in inpatients without COVID-19, it usually needs embolization, and it is associated with high mortality.Copyright © 2023 Silvia Otero-Rodriguez et al.

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