Objective: The current study emphasizes that intramuscular hemorrhage should be considered in cases where low-molecular-weight heparin is applied to prevent and treat hypercoagulability in coronavirus disease-2019 (COVID-19), and these cases should be followed closely because spontaneous bleeding complications may also occur in COVID-19.

Methods: The current study included 24 patients who were hospitalized with a diagnosis of COVID-19 and who had intramuscular bleeding during their follow-up. Data such as gender, age, diabetes, hypertension, cancer history, previous intra-abdominal surgery, coronary artery disease, presence of additional disease such as kidney failure, drugs used before and after hospitalization, and patients’ need for intensive care, and the need for intubation and blood replacement were recorded for all patients.

Results: Of the patients, 16 (66.7%) were male, 8 (33.3%) were female, and the mean age was 71.9 (47-87) years. Comorbidities were present in 18 of the patients. It was seen in radiology reports that 54.2% of intramuscular bleeding developed within the psoas muscle in the retroperitoneum. In 21 (87.5%) patients, erythrocyte replacement therapy was performed in line with the clinical findings because of bleeding. The number of patients whose treatment required intensive care was 14 (58.3%) and 6 (25%) patients had to be intubated. Mortality was seen in 9 (37.5%) patients. The presence of comorbidity, international normalized ratio value, high pressure oxygen therapy, the need for intensive care and the need for intubation showed statistically significant differences in the development of mortality.

Conclusion: To reduce mortality and morbidity due to hypercoagulability that may develop after COVID-19 infection, more studies on how, at what doses and when anticoagulation should be given and the preparation of guidelines for this will be beneficial in treatment management. It is thought that cases with intramuscular bleeding should be observed closely, supportive treatment should be applied promptly, and surgical option should be considered.