A pair of cases studies published in SAGE Open Medical Case Reports suggest that patients with COVID-19 who are treated with heparin may have some risk of developing idiopathic iliopsoas hematoma (IPH).

Recent research since the COVID-19 pandemic began suggests that patients diagnosed with this disease are at a high risk of coagulopathy and venous thromboembolism (VTE). Health bodies recommend the use of heparin, specifically low-molecular-weight heparin, to reduce these risks.

There is, however, some research suggesting that major hemorrhage is a possible risk with COVID-19 infection. Idiopathic IPH, specifically, has been noted, although risk factors for this event have not been described. The authors of the present pair of case studies noted that in a 3-month period in early 2020, of the 19 patients treated for COVID-19 who received low-molecular-weight-heparin, 4 cases of bleeding were noted, including 2 cases of minor hematuria and 2 cases of IPH. The details of the IPH cases were reported in this paper.


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The first patient to develop IPH was a male aged 75 years who was previously diagnosed with chronic obstructive pulmonary disease, and receiving clopidogrel because of carotid atheromatousew plaque development and a previous ischemic stroke. The second patient was a male aged 79 years with obesity who was diagnosed with COVID-19 10 days after symptoms developed.

The first patient developed signs of hyperemia and edematous imbibition 10 days after a heparin dose increase from 4000 IU to 6000 IU; after dose reduction and management of other treatments, the hematoma was reabsorbed after 27 days. The patient was discharged 49 days after initial hospitalization.

The second patient developed a right IPH 14 days after initiating a high dose of heparin. After dose reduction, the hematoma was reabsorbed after 21 days, and the patient was discharged 57 days after initial hospitalization.

“Further studies are needed to assess the hemorrhagic risk of antithrombotic therapy, as well as investigation of pre-existing coagulation defects or those caused by the infection, which may predispose COVID-19 patients to bleeding,” the authors wrote.

Reference

Sottilotta G, Mangano C, Basile R, et al. Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment. SAGE Open Med Case Rep. 2021;9:2050313X211016991. doi:10.1177/2050313X211016991

This article originally appeared on Hematology Advisor