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Melaena and thrombocytopenia: 2 case reports In a single-centered, retrospective case series of six patients between 01 March 2020 and 24 April 2020, two men aged 66-73 years were described; they developed gastrointestinal bleeding or thrombocytopenia after treatment with apixaban, heparin or rivaroxaban [ routes not stated; not all dosages, time to reactions onsets and outcomes stated]. Patient 1 (case#4): A 66-year-old man was diagnosed with SARS-CoV-2 infection, which was complicated by pulmonary embolism. He presented to hospital with an episode of melaena. He previously received heparin and developed heparin-induced thrombocytopenia (HIT). Thereafter, he started receiving apixaban [Eliquis] for 2 weeks due to HIT. He had no prior history of bleeding. Laboratory investigations revealed the following: elevated inflammatory markers, haemoglobin 12.9 g/dL, WBC 9.78 x 103/ mcL, platelets 310 x 103/mcL, PT 21.3s, INR 1.8, CRP 91.4 mg/L, ferretin 11589 ng/mL and D-dimer 3370 ng/mL. He required 2L FiO2 via nasal cannula. His haemoglobin remained stable and he was discharged. Patient 2 (case#6): A 73-year-old man, who had a history of GERD, was diagnosed with SARS-CoV-2 infection. He presented to hospital with shortness of breath and hypoxia. He started receiving prophylactic rivaroxaban [Xarelto]. Laboratory investigations revealed the following: elevated troponin, haemoglobin 9.8 g/dL, WBC 5.59 x 103/mcL, platelets 216 x 103/mcL, PT 14.4s, INR 1.1, ferretin 51 ng/mL and D-dimer 730 ng/mL. Later, he was switched to heparin drip. On day 2 of hospitalisation, he experienced melaena and heparin was stopped. On day 3, he was intubated due to hypoxia and required 100% FiO2. His haemoglobin level stabilised and he started receiving enoxaparin sodium for DVT prophylaxis. He was extubated and received a treatment with remdesivir. Barrett LF, et al. Self-limited gastrointestinal bleeding in COVID-19. Clinics and Research in Hepatology and Gastroenterology 44: e77-e80, No. 4, Sep 2020. Available from: 803503423 URL: http://doi.org/10.1016/j.clinre.2020.06.015

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Reactions 26 Sep 2020 No. 1823