Anticoagulants in COVID-19 trauma: a double edge sword

It is a well established fact how SARS-CoV-2 virus is associated with increased risk of thromboembolic events but less data is available about management of COVID-19 patients with abdominal trauma. Material and methods. 68-year-old female presented with an alleged history of Road Traffic Accident with blunt abdominal injury. Imaging of the abdomen showed mild haemoperitoneum with no solid organ injury. She also had breathlessness and on evaluation found to have moderate COVID-19. She was managed conservatively and started on anticoagulants in view of moderate COVID-19. On the 4th day of admission, the patient complained of sudden onset of pain in abdomen, abdominal distension with features of peritonitis. On imaging by CECT abdomen and pelvis showed large retroperitoneal hematoma compressing upon the right kidney anteriorly and right colon posteriorly. In view of peritonitis, the patient underwent exploratory laparotomy. Intra op finding showed large retroperitoneal hematoma compressing the right colon with posterior wall gangrene. Patient underwent a right hemicolectomy with covering ileostomy. Post op patient had a wound infection which was managed with regular dressings. On follow up patient underwent ileostomy reversal after 8 weeks. Herein, we present an intriguing case, where thromboprophylaxis in a COVID-19 infected patient with abdominal trauma led to retroperitoneal hematoma. Conclusion. It is a general consensus that anticoagulant therapy must be recommended for prophylaxis in patients with moderate COVID-19 to reduce risk of thromboembolic events. Our case shines light upon the topic of hemostasis disturbance and increased risk of bleeding requiring serial monitoring and rapid imaging in co-management of COVID-19 with abdominal trauma.