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Spontaneous bleeding in COVID-19: A retrospective experience of an Italian COVID-19 hospital

Mirko Trentadue
Plinio Calligaro
Gianluigi Lazzarini
Fabio Bonomi Boseggia
Elena Residori
Jennifer Hu
Silvana Vanti
Linda Lillo


Background: Haemorrhages in coronavirus disease 2019 (COVID-19) patients require proper knowledge and management.
Objectives: To highlight the characteristics of haemorrhages in patients with COVID-19 infection.
Method: A retrospective study examined CT scans performed over a 13-month period in patients hospitalised with COVID-19 infection to determine those who developed spontaneous bleeding. The authors also investigated correlations between the bleeding events and the patients’ characteristics.
Results: Haemorrhages occurred in 2.22% (31/1396) of patients hospitalised with COVID-19 infection (7.88%, 19/241 in the intensive care unit). Bleeding, major in most cases, occurred in anticoagulated patients, especially males with multiple comorbidities, aged between 60 and 79 years and mainly appeared in a single anatomical region (especially retroperitoneal), with the most voluminous in the chest wall. The complication was diagnosed on average 16.7 days after admission and occurred predominantly in critically ill patients undergoing invasive ventilation and pronation-supination cycles. In just under half of the cases, the haematomas were active, and in these cases, mainly with a single contrast blush and with earlier onset after the start of anticoagulation than in non-active bleeding. Major bleeding was also earlier in the presence of multiple morbidity. The vast majority of patients were treated conservatively and survived.
Conclusion: At COVID-19 hospital centres, it is advisable that there is knowledge of such a complication for which CT imaging is essential for diagnosis and proper management. Although some authors have expressed doubts about anticoagulant treatment in patients with COVID-19, the bleeding complication in this study did not significantly affect the outcome.
Contribution: Spontaneous haemorrhage did not significantly affect the outcome in this series.