Vaskulárna medicína 1/2023

Gastrointestinal bleeding in patients with COVID-19

Introduction: In COVID-19, in addition to symptoms of respiratory system involvement, symptoms of gastrointestinal tract involvement are frequent comorbidity. Thromboembolic events are also a common complication of the disease, leading to the early and frequent indication of prophylactic and therapeutic antithrombotic therapy. The incidence of gastrointestinal symptoms in COVID-19 is reported to range from 3 to 61%. These include gastrointestinal bleeding, often made more potent by antithrombotic therapy. Recent studies report a risk rate for GI bleeding ranging from 1.1 to 13%. Methods: In our retrospective study, 30 patients with COVID-19 (one colonoscopic examination and 29 esophagogastroduodenoscopies) were examined endoscopically for signs of acute bleeding. Acutely, 24 patients without COVID-19 were colonoscopically examined and 178 patients underwent esophagogastroduodenoscopy. We present the differences in the findings of the different groups. Results: The most common cause of bleeding in patients with COVID-19 was antral and oesophageal erosions. Additionally, most patients with bleeding had anticoagulants and a combination of anticoagulant and antithrombotic therapy in their therapy. Conclusion: Haemorrhagic complications in patients with COVID-19 are relatively common due to antithrombotic therapy and require complex management. Due to often present respiratory distress, acute endoscopies are postponed until the patient stabilises and conservative treatment is chosen, which may often be more beneficial for the patient with a more severe course of COVID-19.

Keywords: COVID-19, haemorrhage, SARS-CoV-2, acute endoscopy, antithrombotic therapy