Abdominal lateral wall hematoma developed due to enoxaparin in a Covid-19 patient

A 43-year-old male patient without any additional disease, surgery or anticoagulant use admitted to the emergency department. After evaluation with computed tomography (CT), pulmonary findings were consistent with COVID-19 pneumonia. The patient was hospitalized and enoxaparin sodium 60 mg / 0.6 ml (two subcutaneous injections per day) was initiated for prophylactic purpose. In the 16th day after admission, his hemoglobin level decreased to 7.4 g/dL. On CT scan, a right flank hematoma reaching approximately 10 cm in width, starting from the subcostal level and continuing to the inguinal canal level, was seen. Anticoagulant therapy was stopped. Erythrocyte suspension (ES), totally 10 units, were given to keep the hemoglobin level above 7 g/dL. On the 32th day after admission, the patient was discharged because his hemoglobin value, which was 10.2 g/dL at that point, had not decreased, his vital signs were stable, and his treatment for COVID-19 was completed.

___

  • 1. Çolakoğlu MK, Özdemir A, Kalcan S, Demir A, Demiral G, Pergel A. Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. Turkish Journal of Trauma and Emergency Surgery. 2020;26(1):50-4.
  • 2. Dennison JJ, Carlson S, Faehling S, Phelan H, Tariq M, Mubarik A. Splenic infarction and spontaneous rectus sheath hematomas in COVID-19 patient. Radiology Case Reports. 2021;16(5):999-1004.
  • 3. Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. Journal of thrombosis and thrombolysis. 2020:1-4.
  • 4. Han H, Yang L, Liu R, Liu F, Wu K-l, Li J, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;1(ahead-of-print).
  • 5. Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. Journal of thrombosis and thrombolysis. 2020;50:72-81.
  • 6. Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, et al. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID‐19. Journal of Thrombosis and Haemostasis. 2020;18(8):1859-65.
  • 7. Risch O, Alfidja A, Mulliez A, Amani AH, Boyer L, Camilleri L, et al. Severe non-traumatic bleeding events detected by computed tomography: do anticoagulants and antiplatelet agents have a role? Journal of cardiothoracic surgery. 2014;9(1):1-6.
  • 8. Aktürk OM, Kayılıoğlu SI, Aydoğan İ, Dinç T, Yildiz B, Cete M, et al. Spontaneous rectus sheath hematoma: an overview of 4-year single center experience. Indian Journal of Surgery. 2015;77(3):1219-21.
  • 9. Pei M-W, Hu M-R, Chen W-B, Qin C. Surgical Treatment of a Giant Spontaneous Abdominal Wall Hematoma. Chinese medical journal. 2017;130(13).