Coagulopathy in COVID-19 Patients and Endovascular Treatment, Reports of 4 Patients

COVID-19 pandemic due to the respiratory infection of SARS-CoV-2 has now become a global threat. The thrombotic complications are common in COVID-19 patients which have been extensively addressed in various studies. The hemorrhagic complications, however, have received less attention. In this article, 4 cases of COVID-19 patients with hemorrhagic complications are presented. All 4 patients were hospitalized in ICU and received routine COVID-19 treatments such as heparin prophylaxis. During hospitalization, all four patients had rectus sheath hematoma and retroperitoneal hemorrhage. They underwent embolization to control hemorrhage. Embolization of the inferior epigastric artery and the anterior trunk of internal iliac artery was carried out under fluoroscopy-guided angiography. The active hemorrhage of the patients was controlled. Three patients recovered after the treatment and were discharged while one patient, unfortunately, died due to the severity of the pulmonary involvement, old age, and hemorrhage. First, the hemorrhage of these patients was assigned to the hemorrhagic complications due to the use of heparin. But the hemorrhage volume was not justifiable with the symptoms and complications of prophylaxis dosage of heparin. The attention was gradually drawn to the coagulopathy of the COVID-19 patients. further investigations are required to clarify the role of effective factors and complications of coagulopathy in patients with COVID-19 and their appropriate treatment.