MO755SPONTANEOUS SOFT TISSUE HEMATOMAS IN ESRD PATIENTS WITH SYMPTOMATIC SARS-CO-V2 INFECTION – THE EXPERIENCE OF AN EMERGENCY NEPHROLOGY AND DIALYSIS DEPARTMENT

BACKGROUND AND AIMS: While actual proofs plead for an increased thrombotic risk in SARS-Co-V2 infection and need for anticoagulant therapy in severe cases, we report suspicious occurrence of hemorrhagic events in a series of ESRD patients. METHOD: 59 patients with stage 5 CKD were hospitalized in a two months interval, since our hospital was designated for the admission of mild-severe SARS-Co-V2 patients exclusive. 8 patients were admitted for RRT initiation and 51 were maintenance dialysis patients admitted with SARS-Co-V2-associated complications. Beside hemodialysis and treatment of chronic complications of ESRD, all patients were treated, according to the stage and gravity of SARS-Co-V2 infection and under continuous supervision of an infectious disease physician, with antivirals, antibiotics, anticoagulants and IL-antagonists. Daily or at 2 days laboratory monitoring was performed and consisted in evaluation of inflammatory markers, clotting tests, complete hemogram, D-dimer testing, IL-1 and IL-6 serum levels, serum urea, creatinine and albumin. RESULTS: In 6 cases spontaneous soft tissue hematomas were noted, totalizing a number of 9 hematomas documented through ultrasound and CT-scan. In order of frequency, the locations were: 4 rectus abdominalis hematoma, 2 in the external oblique, 2 in gluteus maximus muscle, and one in the right psoas muscle. The source of the bleeding could not be identified in any patient. The occurrence of spontaneous hematomas was correlated with the D-dimer values (p=0.02), prolonged anticoagulation (over 7 days), albumin levels (p=0.01), platelets count (p=0.05). We found no correlation with the serum urea, creatinine, hemoglobin, INR, or with the dialysis age. In all these cases cough was severe. A conservative approach was instituted, with daily US monitoring, withdrawal of anticoagulants and antiplatelet medication, and blood transfusions. 2 patients necessitated surgical procedures and two deaths were recorded. CONCLUSION: In this brief report, we observed that in chronic hemodialysis patients infected with SARS-Co-V2, risk of hemorrhagic manifestations may overcome the benefits of anticoagulant routine therapy. There is a need to explore further this risk in the future;until then, a careful individualized assessment of the safety and indications for anticoagulant therapy regimens is mandatory for ESRD patients with symptomatic new Coronavirus infection.