key: cord-0705611-9t96nbbj
authors: Das, Abhay Kumar; Price, Toby; Woodcock-Shaw, Joshua; Zava, Ngoni Khomisani
title: Spontaneous psoas haematoma from enhanced venous thromboembolism (VTE) prophylaxis for COVID-19 infection
date: 2021-09-30
journal: Age Ageing
DOI: 10.1093/ageing/afab181
sha: 7cfa8e7e7d765c7635e0e00644529e01106ab7c4
doc_id: 705611
cord_uid: 9t96nbbj

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• COVID-19 increases venous thromboembolism (VTE) risk.

• Enhanced low-molecular weight heparin (LMWH) regime required in COVID-19. • Increased spontaneous internal bleed. • Imaging to exclude internal bleed. • Individualise treatment in older people.

An 89-year-old female patient dropped her haemoglobin by over 40 g/l, and hence required blood transfusion whilst being treated for COVID-19 pneumonia. She had no external bleeding and physical examination was unremarkable. Computed tomography imaging revealed that she had a large right-sided psoas haematoma ( Figure 1) . Sadly, the patient died despite active treatment.

All adult patients are required to be assessed for venous thromboembolism (VTE) prophylaxis (NG 89). This patient received an enhanced regime of low-molecular weight heparin (LMWH) as per NICE guidelines (NG 186) due to the increased risk of VTE in COVID-19. [1] Unilateral spontaneous psoas haematomas have previously been described in the use of the standard prophylactic dose of LMWH. [2] These often present with non-specific symptoms, and hence, diagnosis can be difficult. [3] Older patients, often with multiple co-morbidities require tailored treatment plans in the prevention of VTE in COVID-19 due to the risk of internal bleeding. Patients with a fall in haemoglobin and no clinical findings may benefit from radiological investigation to exclude spontaneous internal haemorrhage.

Declaration of Sources of Funding: None. 

Thromboembolism risk of covid-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysis

Iliopsoas haematoma associated with low-molecular weight heparin use: a case report

Psoas haematoma in the elderly patient, a diagnostic challenge, a case report