Shiraki Hideto, Morishita Koji, Kishino Mitsuhiro, Nakatsutsumi Keita, Kimura Koichiro, Shirai Tsuyoshi, Ishizuka Masahiro, Miyazaki Yasunari, Aiboshi Junichi, Otomo Yasuhiro
Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
Department of Diagnostic Radiology, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
Open Access Emerg Med. 2021 May 24;13:207-211. doi: 10.2147/OAEM.S302732. eCollection 2021.
Anticoagulant therapy for patients with severe coronavirus disease (COVID-19) pneumonia is considered to improve the hypercoagulable and inflammatory state. However, bleeding complications should also be considered.
A 77-year-old man with a history of falls was diagnosed with COVID-19. Owing to his severe condition, he was intubated and transferred to our hospital for intensive care. Favipiravir, tocilizumab, unfractionated heparin, and ART-123 were administered to treat COVID-19 and manage the antithrombotic prophylaxis for paroxysmal atrial fibrillation (Af). On the 6th day after admission, a hematoma was noted on the left chest wall. Computed tomography (CT) revealed multiple hematomas, including hematomas on his chest wall and obturatorius internus muscle. Emergency angiography transcatheter embolization (TAE) was performed. The patient was transferred to another hospital 23 days after TAE, without complications.
Our findings show that anticoagulation therapy and a history of falls induced multiple hematomas in a COVID-19 patient and that the condition was managed with TAE. When anticoagulants are considered in the management of Af and COVID-19 associated coagulopathy, it is necessary to closely monitor potential bleeding complications.
对于重症冠状病毒病（COVID-19）肺炎患者，抗凝治疗被认为可改善高凝和炎症状态。然而，出血并发症也应予以考虑。
一名77岁有跌倒史的男性被诊断为COVID-19。由于病情严重，他接受了气管插管并转至我院重症监护室。给予法匹拉韦、托珠单抗、普通肝素和ART-123治疗COVID-19并预防阵发性心房颤动（房颤）的血栓形成。入院第6天，左侧胸壁发现血肿。计算机断层扫描（CT）显示多处血肿，包括胸壁和闭孔内肌的血肿。进行了急诊血管造影经导管栓塞术（TAE）。TAE术后23天患者转至另一家医院，无并发症。
我们的研究结果表明，抗凝治疗和跌倒史导致一名COVID-19患者出现多处血肿，该情况通过TAE得到处理。在房颤和COVID-19相关凝血病的管理中考虑使用抗凝剂时，有必要密切监测潜在的出血并发症。
