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Case report
Double-edged sword effect of anticoagulant in COVID-19 infection
  1. May Honey Ohn1,
  2. Jun Rong Ng2,
  3. Khin Maung Ohn3 and
  4. Ng Pey Luen4
  1. 1Cardiology Department, Lewisham Hospital NHS Trust, London, UK
  2. 2Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  3. 3Surgical Department, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  4. 4Emergency Department, Miri Hospital, Miri, Sarawak, Malaysia
  1. Correspondence to Professor Khin Maung Ohn; drkmgohn{at}ums.edu.my

Abstract

Coagulation predominant-type coagulopathy such as microthrombosis and macrothrombosis is a well-known recognised complication found in COVID-19 infected critically ill patients. In the context of high incidence of thrombotic events in patients with COVID-19, supplementation with anticoagulant therapy has been routinely recommended and shown to reduce mortality. However, the recommended type, dose, duration and timing of anticoagulant has not been determined yet. Spontaneous retroperitoneal haematoma secondary to anticoagulant therapy is one of the well-known but self-limiting conditions. We report a 51-year-old COVID-19 positive woman, who was taking intermediate-intensity heparin therapy for venous thromboembolism prophylaxis and died from complication of retroperitoneal bleeding. Further studies are needed to verify the risk–benefit ratio of anticoagulant therapy in patients with COVID-19. Although anticoagulant deems appropriate to use in patients with COVID-19, clinicians should be cautious about major bleeding complication such as retroperitoneal haemorrhage even when full therapeutic dosage is not used.

  • COVID-19
  • haematology (drugs and medicines)
  • acute renal failure
  • pneumomediastinum
  • haematology (incl blood transfusion)

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-241955

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    Footnotes

    • Contributors MHO involves in the management of the patient. She wrote the initial draft of the article. JRN and NPL performed the literature search and wrote the final draft of the article and case description. KMO has provided the appropriate guidance to write and publish the article. MHO revised the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.