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. 2021 Sep 12;10(18):4119.
doi: 10.3390/jcm10184119.

Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed?

Pascale Riu  1 , Fabrizio Albarello  2 , Federica Di Stefano  2 , Alessandra Vergori  3 , Alessandra D'Abramo  4 , Carlo Cerini  3 , Martina Nocioni  5 , Maurizio Morucci  1 , Nardi Tetaj  5 , Massimo Cristofaro  2 , Vincenzo Schininà  2 , Paolo Campioni  2 , Ada Petrone  2 , Nicoletta Fusco  2 , Luisa Marchioni  5 , Andrea Antinori  3 , Emanuele Nicastri  4 , Roberto Cianni  1 , Stefania Ianniello  2
Affiliations

Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed?

Pascale Riu et al. J Clin Med. .

Abstract

Background: critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization.

Methods: We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected.

Results: 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05).

Conclusions: PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.

Keywords: COVID-19; low-molecular-weight heparin; percutaneous trans arterial embolization; spontaneous bleeding.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Severity criteria within the two groups: (A) Dimension of the hematoma (considered as the sum of the two major diameters on the three planes ÷ 2); (B) % of dropping of hemoglobin (>2–3 g/dL).
Figure 2
Figure 2
Severity criteria detected with computed tomography and overall survival.
Figure 3
Figure 3
(A) Arterial phase CT and (B) late phase CT of a right retroperitoneal and ileo-psoas hematoma. Note multiple arterial intralesional blushes (arrow in (A)) show a contrast late enhancement (arrow in (B)).
Figure 4
Figure 4
(A) Catheterism of the right hypogastric artery to reach the right ileo-lumbar artery (anastomotic territory); (B) Lumbar artery catheterization showing tiny bleeding spots; (C) Post-embolization angiogram: right lumbar arteries occluded; (D) Stop flow post embolization with particles (PVA contour 350–500) in the 4th lumbar artery and coil in the 5th lumbar artery (arrow).
See this image and copyright information in PMC

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