{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T20:51:59Z","timestamp":1761598319196,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,9]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Coagulation predominant-type coagulopathy such as microthrombosis and macrothrombosis is a well-known recognised complication found in COVID-19 infected critically ill patients. In the context of high incidence of thrombotic events in patients with COVID-19, supplementation with anticoagulant therapy has been routinely recommended and shown to reduce mortality. However, the recommended type, dose, duration and timing of anticoagulant has not been determined yet. Spontaneous retroperitoneal haematoma secondary to anticoagulant therapy is one of the well-known but self-limiting conditions. We report a 51-year-old COVID-19 positive woman, who was taking intermediate-intensity heparin therapy for venous thromboembolism prophylaxis and died from complication of retroperitoneal bleeding. Further studies are needed to verify the risk\u2013benefit ratio of anticoagulant therapy in patients with COVID-19. Although anticoagulant deems appropriate to use in patients with COVID-19, clinicians should be cautious about major bleeding complication such as retroperitoneal haemorrhage even when full therapeutic dosage is not used.<\/jats:p>","DOI":"10.1136\/bcr-2021-241955","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T13:11:23Z","timestamp":1616418683000},"page":"e241955","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Double-edged sword effect of anticoagulant in COVID-19 infection"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1951-6598","authenticated-orcid":false,"given":"May Honey","family":"Ohn","sequence":"first","affiliation":[{"name":"Cardiology Department, Lewisham Hospital NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun Rong","family":"Ng","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khin Maung","family":"Ohn","sequence":"additional","affiliation":[{"name":"Surgical Department, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ng Pey","family":"Luen","sequence":"additional","affiliation":[{"name":"Emergency Department, Miri Hospital, Miri, Sarawak, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,22]]},"reference":[{"key":"2025082700264162000_14.3.e241955.1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14817"},{"key":"2025082700264162000_14.3.e241955.2","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-238168","article-title":"Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis","volume":"13","author":"Vadukul","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2025082700264162000_14.3.e241955.3","doi-asserted-by":"crossref","first-page":"458","DOI":"10.14740\/jocmr4256","article-title":"Life-Threatening psoas hematoma due to retroperitoneal hemorrhage in a COVID-19 patient on enoxaparin treated with arterial embolization: a case report","volume":"12","author":"Patel","year":"2020","journal-title":"J Clin Med Res"},{"key":"2025082700264162000_14.3.e241955.4","first-page":"e9772","article-title":"Spontaneous retroperitoneal bleed coincided with massive acute deep vein thrombosis as initial presentation of COVID-19","volume":"12","author":"Erdinc","year":"2020","journal-title":"Cureus"},{"key":"2025082700264162000_14.3.e241955.5","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ejim.2020.05.002","article-title":"Bleeding in COVID-19 severe pneumonia: the other side of abnormal coagulation pattern?","volume":"77","author":"Conti","year":"2020","journal-title":"Eur J Intern Med"},{"key":"2025082700264162000_14.3.e241955.6","unstructured":"Pia MI , Islam T . Renal and bleeding complications in critically ill Covid-19 Patient-A case report."},{"key":"2025082700264162000_14.3.e241955.7","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.thromres.2020.08.035","article-title":"Anticoagulation and bleeding risk in patients with COVID-19","volume":"196","author":"Musoke","year":"2020","journal-title":"Thromb Res"},{"key":"2025082700264162000_14.3.e241955.8","doi-asserted-by":"crossref","unstructured":"Gomez K , Laffan M , Bradbury C . Debate: should the dose or duration of anticoagulants for the prevention of venous thrombosis be increased in patients with COVID-19 while we are awaiting the results of clinical trials? Br J Haematol 2020.","DOI":"10.1111\/bjh.17241"},{"key":"2025082700264162000_14.3.e241955.9","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14768"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241955","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:26:48Z","timestamp":1756279608000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":9,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,22]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bcr-2021-241955"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241955","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}