Golkar Mohsen, Taheri Anita, Baseri Milad, Nikraftar Parnian, Ansari Ramin, Khorsand Ardeshir
Department of Oral and Maxillofacial Surgery, Dentistry Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Case Rep Med. 2025 May 24;2025:3371235. doi: 10.1155/carm/3371235. eCollection 2025.
COVID-19 is associated with a hypercoagulable state, often managed with anticoagulation therapy to prevent thrombotic events. However, anticoagulation can lead to rare but serious bleeding complications. We present the case of a 62-year-old male with severe COVID-19 admitted to the intensive care unit (ICU) with shortness of breath, cough, and oxygen desaturation. Also, he had diabetes, undergoing treatment with Neutral Protamine Hagedorn (NPH) insulin, and ischemic heart disease. On the eighth day of his admission, he developed a spontaneous sublingual hematoma while on unfractionated heparin therapy. The patient was managed conservatively with blood pressure control, cold compresses, adjustment of anticoagulation and close monitoring with laboratory anticoagulation tests, and careful observation. Despite the hematoma's initial enlargement, he exhibited no respiratory distress, and the hematoma gradually resolved without surgical intervention. This case highlights the need for vigilant monitoring, careful management of anticoagulation, and a multidisciplinary approach in balancing the benefits and risks of anticoagulation in COVID-19 patients.
新型冠状病毒肺炎（COVID-19）与高凝状态相关，通常采用抗凝治疗来预防血栓形成事件。然而，抗凝治疗可能导致罕见但严重的出血并发症。我们报告一例62岁男性重症COVID-19患者，因呼吸急促、咳嗽和氧饱和度下降入住重症监护病房（ICU）。此外，他患有糖尿病，正在接受中效胰岛素（NPH）治疗，并有缺血性心脏病。入院第8天，他在接受普通肝素治疗时出现自发性舌下血肿。患者通过控制血压、冷敷、调整抗凝治疗以及实验室抗凝检测密切监测和仔细观察进行保守治疗。尽管血肿最初有所增大，但他未出现呼吸窘迫，血肿在未进行手术干预的情况下逐渐消退。该病例凸显了在COVID-19患者中对抗凝治疗的益处和风险进行权衡时，需要进行密切监测、谨慎管理抗凝治疗以及采取多学科方法。
