Bir COVID-19 Hastasında Profilaktik Subkutan Enoksaparin Tedavisi Sonrası Rektus Kılıf Hematomu

Öz

COVID-19, solunum yetmezliği ile birlikte mikrovasküler tromboza neden olan bir hastalıktır. Antikoagülan tedaviler bazen yaşamı tehdit eden gastrointestinal, intrakraniyal ve abdominal kanamaya neden olur.68 yaşındaki erkek hasta, acil serviste yapılan COVID-19 PCR-RT testinin pozitif olması ve toraks tomografisinde COVID-19 pnömonisi ile uyumlu olması nedeniyle enfeksiyon hastalıkları servisine kabul edildi. Hastanın hipertansiyon ve koroner arter hastalığına bağlı mikrovasküler tromboz riskinin yüksek olacağı düşünülerek profilaktik subkutan enoksaparin tedavisi başlandı. Tedavisinin 10. gününde, genel durumu kötüleşen ve şiddetli karın ağrısı gelişmesi üzerine, tanı amaçlı olarak bakılan hemoglobin incelemesinde hemoglobin 6,4 mg/dl,ve batın tomografisinde ise rektus kılıfından başlayarak pelvise yayılan 15x11x14 cm abadlı hematom tespit edilmesi üzerine rektus kılıf hematomu tanısı konuldu.

Anahtar Kelimeler

• COVID-19
• hematom
• enoksaparinsodyum
• bilgisaraylı tomografi

Rectus Sheath Hematoma After Prophylactic Subcutaneous Enoxaparin Treatment in a COVID-19 Patient

Öz

COVID-19 is a disease that causes microvascular thrombosis with respiratory failure. Anticoagulant treatments sometimes cause life-threatening gastrointestinal, intracranial, and abdominal bleeding. A 68-year-old male patient was admitted to the infectious diseases service because the COVID-19 PCR-RT test performed in the emergency department was positive and it was compatible with COVID-19 pneumonia on thoracic tomography. Prophylactic subcutaneous enoxaparin treatment was initiated considering that the patient would have a high risk of microvascular thrombosis due to hypertension and coronary artery disease. On the 10th day of his treatment, the patient whose general condition was deteriorated and had severe abdominal pain, hemoglobin was 6.4 mg/dl in the hemoglobin examination performed for diagnosis, and a diagnosis of hematoma spreading to the pelvis starting from the rectus sheath of 15x11x14 cm was made in abdominal tomography.

Anahtar Kelimeler

• COVID-19
• hematoma
• enoxaparinsodium
• computed tomography.

Kaynakça

1. 1- Johns Hopkins Coronavirus Resource Center [Internet]. John-Hopkins University &Medicine;2020 [cited ].2020Available form:https://coranavirüs.jhu.edu/data/mortality.
2. 2- Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584 (7821):430-6.
3. 3-Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020 ;18(7):1559-61.
4. 4- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z,et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China:a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
5. 5-Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-40.
6. 6-Cherry WB, Mueller PS. Rectus sheath hematoma:review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105-10.
7. 7- Velicki L, Cemerlić-Adić N, Bogdanović D, Mrdanin T. Rectus sheath haematoma: enoxaparin-related complication. Acta Clin Belg. 2013 ;68(2):147-9.
8. 8-Denard PJ, Fetter JC, Zacharski LR. Rectus sheath hematoma complicating low-molecular weight heparin therapy. Int J Lab Hematol. 2007;29:190-4.

9. 9-Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, da Silva LFF, de Oliveira EP, Saldiva PHN, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. 2020;18(6):1517-9.
10. 10-Iba T, Levy JH, Levi M, Trachil J. Coagulopathy in COVID-19. J Thromb Haemost. 2020;18(9):2103-9
11. 11-Gadiparthi C, Perisetti A, Sayana H, Tharian B, Inamdar S, Korman A.Gastrointestinal Bleeding in Patients with Severe SARS-CoV-2. Am J Gastroenterol. 2020 Aug;115(8):1283-5.
12. 12-Gogia B, Fang X, Rai P. Intracranial Hemorrhage in a Patient With COVID-19:Possible Explanations and Considerations. Cureus. 2020 Aug 31;12(8):e10159.
13. 13-Patel I, Akoluk A, Douedi S, Upadhyaya V, Mazahir U, Costanzo E, et al. Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization:A Case Report. J Clin Med Res. 2020;12(7):458-61.
14. 14-Matalon SA, Askari R, Gates JD, Patel K, Sodickson A D, et al. Don’t forget the abdominal wall: Imaging spectrum of abdominal wall injuries after nonpenetrating trauma. Radiographics 2017;37(4):1218-1235.
15. 15-Özdemir M, Taydaş O, Öztürk M. COVID-19 Enfeksiyonunda Toraks Bilgisayarlı Tomografi Bulguları. J Biotechinol & Strategic Health Res. 2020;4:91-96.