ABSTRACT
Introduction: Abdominal haematomas are an uncommon complication of subcutaneous injection of low molecular weight heparin (LMWH) although the latter is widely administered. Aim(s): To review clinical cases of abdominal haematomas following subcutaneous LMWH injection, discover the root causes and identify appropriate solutions to improve clinical practice. Material(s) and Method(s): Retrospective case review of all clinical cases linked to abdominal haematomas secondary to LMWH injection. Result(s): Between 09.2020-01.2022, 760 patients were admitted in our Department due to COVID19 pneumonia. 4 cases of abdominal haematomas were reported (all females, mean age 70.5 years). All patients received therapeutic LMWH(3 for atrial fibrillation). All patients presented haematomas on rectus abdominis muscle and subsequently in the pelvic area. All patients presented with haemodynamic instability and required blood transfusions. Clinical outcomes included death (1), nephrostomy (1) (due to haematoma expansion and ureteral obstruction) and prolonged hospital stay by 12 days (2). Route cause analysis revealed improper injection technique in the following order;narrow abdominal margins, no skin folding, injection speed<10secs. Solutions were identified and followed including multidisciplinary nursing re-training that was implemented across the board and was accompanied by continuous monitoring of nursing practice. Conclusion(s): The rare complication of abdominal haematomas following LMWH was closely reviewed in our department and was turned into an opportunity to reconsider daily clinical practice, to contribute to quality improvement and improve patient safety.
ABSTRACT
BACKGROUND: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. OBJECTIVES: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. METHODS: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. RESULTS: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05). CONCLUSIONS: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.