OBJECTIVE
Aim of the study: to analyze the short-term treatment outcomes for patients with COVID-19 and hematomas of different localizations.
MATERIAL AND METHODS
The profile of hospital admissions of Sokolov North-West Regional Scientific and Clinical Center changed at November 6th, 2020. 1.878 patients with COVID-19 were admitted in the hospital from November 6th, 2020 and March 2nd, 2021. 25 people (1.1%) of admitted patients developed hematomas. The average age was 70±5.6 years. They were no mild forms of the disease. Anticoagulants were used in all cases from the 1st day of hospitalization. The volume of lung damage corresponded to CT-4 in 48% of patients, CT-3 in 2 (8%) patients and CT-2 — in 11 (44%) patients. The methods of diagnostic imaging of hematomas were CT, ultrasound, and laparoscopy.
RESULTS
Hematomas were represented by deep intramuscular hematomas in 96% (24 patients). The typical localization of the hematomas was rectus muscle of the anterior abdominal wall (12 patients). Chest wall hematoma was detected less often (5 patients) and limb hematomas (3 patients). Retroperitoneal hematoma was observed in 2 patients, gluteal hematoma — in 1 patient. There was a combination of hematomas of various anatomical areas in 2 patients: in one patient — in the anterior abdominal wall and hip, in the second — in the anterior abdominal wall and pelvis. Blood transfusion was performed in 12 patients (48%). Risk factors of hematomas formation were: initially critical or fast progression of lung lesion volume in patients with COVID-19, comorbidity of patients, the presence of obesity and an increased level of D-dimer. These risk factors were associated with intensified anticoagulant therapy. Out of 25 patients, 8 (32%) people underwent surgical procedures, hematoma punctures were performed in 6 (24%) patients, and 11 (44%) patients received conservative therapy. The mortality rate was 40% (10 patients). The cause of death was progressive pneumonia (9 patients) and disseminated intravascular coagulation syndrome (1 patient).
CONCLUSION
Hematomas of different sites can occur in COVID-19 patients upon anticoagulation treatment. The decision making process in such cases should be determined by the severity of the patient’s condition and lung damage, the localization of the hematoma, the amount of blood loss, the dynamics of the volume of the hematoma, and the proportion of the fluid component in it according to ultrasound or CT. The development of hematomas in COVID-19 patients is associated with poor prognosis.
