Spontaneous abdominal bleeding associated with SARS-CoV-2 infection: causality or coincidence?

Authors present 3 cases of abdominal bleeding associated with COVID-19, representing 2.7 % of all hospitalized COVID-19 patients and hypothesize that there could be, although not very frequently, a relationship between SARS-CoV2 and bleeding. They excluded a side effect of the low molecular weight heparin therapy that all patients underwent during the course of the disease or other possible causes. Alterations of the coagulation state or a weakness of the vascular wall due to a presumed endotheliitis SARS-CoV-2 infection induced, are hypothesized by the authors. Investigation and follow-up for possible hemorrhagic problems in patients with COVID-19 is recommended. More studies are needed to understand if COVID-19 can be directly associated with bleeding.