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Bleeding: 14 case reports In a single-centre, observational study of 270 adult patients, who had Covid-19 and received thromboprophylaxis treatment at Hospital La Carita, Switzerland between 01 April 2020 and 06 May 2020, 14 patients (9 men and 5 women, aged 58–87 years) were described, who developed major bleeding at the sites of muscle, retroperitoneal, oropharynx, CNS, tracheostomy or pulmonary during treatment with aspirin, clopidogrel, enoxaparin sodium or heparin [not all routes, dosages and outcomes stated, times to reactions onsets not stated]. All 14 patients were hospitalised because of Covid-19-related pneumonia (4 patients) or acute respiratory distress syndrome (10 patients) in 2020. All patients had a risk of thrombosis mainly because of atrial fibrillation, catheter-associated thrombosis and pulmonary embolism. Given the risk of thrombosis, 11 patients started receiving thromboprophylaxis treatment with SC enoxaparin [enoxaparin sodium] at a dose of 60–100mg twice daily, while three patients started receiving heparin [unfractionated heparin]. Five out of 14 patients also receiving antiplatelet therapy with aspirin (3 patients) and clopidogrel (2 patients). Concomitantly, all patients had been receiving unspecified treatment as per Covid therapy protocol. After 3–54 days of initiation hospitalisation, all patients developed major bleeding at the sites of muscle (6 patients), retroperitoneal (3 patients), oropharynx and muscle (1 patient), oropharynx (1 patient), CNS (1 patient), tracheostomy (1 patient) and pulmonary (1 patient). Laboratory investigations showed high levels of D-dimer for all patients, and abnormal platelet levels were noted in 12 patients. Hence, 11 of the 14 patients received unspecified treatment in the ICU. However, three patients died due to major bleedings manifested as muscle bleeding (1 patient), CNS bleeding (1 patient) and pulmonary bleeding (1 patient). Six patients remained hospitalised, while two patients were discharged from hospital. The remaining three patients died because of non-ST-elevation myocardial infarction (1 patient), multi-organ failure (1 patient) and liver failure (1 patient) [aetiologies not stated]. Kessler C, et al. Bleeding prevalence in COVID-19 patients receiving intensive antithrombotic prophylaxis. Journal of Thrombosis and Thrombolysis 50: 833-836, No. 4, Nov 803519360 2020. Available from: URL: http://doi.org/10.1007/s11239-020-02244-y

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Reactions 5 Dec 2020 No. 1833