rectus sheath hematomas in COVID patients on anticoag

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Julie Kindsfater
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Joined: 11/04/2011 - 10:15
rectus sheath hematomas in COVID patients on anticoag

Has anyone else identified an uptick in rectus sheath hematomas in COVID patients?

This should be a relatively rare phenomenon, and my org saw 10 cases in the last 90 days - 9 of those in COVID patients, at least 3 requiring embolization in IR. COVID patients have multiple risk factors and the combination of anticoag prophylaxis when they are hospitalized + abdominal injections + abdominal strain from coughing +/- steroids some receive +/- advanced age of many of the hospitalized COVID patients could - theoretically - be contributory. We issued a systemwide SBAR to raise awareness, not suggesting causation but noting risk factors, to 1) remind RNs of appropriate injection technique/need to inject away from rectus sheath/epigastric arteries/at least 2 inches from umbilicus, 2) increase awareness of this complication and signs/symptoms since it is usually rare. Patients can experience profound H&H drop and need CT scan for diagnosis, and as above, in some cases embolization is needed.

Curious if anyone has seen, and also posting as FYI/raise awareness. No association at my org obese vs. non obese, prophy vs. treatment dose (all adjusted for renal function). Cases occurred after 3-16 doses.

Full disclosure - I have not looked at is cases in COVID or non-COVID patients not on anticoag yet.