TITLE

A Retroperitoneal Bleed Induced by Enoxaparin Therapy

AUTHOR(S)
Ernits, Martin; Mohan, Pradeep S.; Fares, Louis G.; Hardy, Howard
PUB. DATE
May 2005
SOURCE
American Surgeon;May2005, Vol. 71 Issue 5, p430
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Retroperitoneal bleeding is one of the most serious, potentially lethal complications of anticoagulalion therapy. Although well documented in fully heparinized and coumadinized patients, there are only few reports of life-threatening hemorrhages in low-molecular-weight heparin (LMWH)-treated patients. We present a case of almost fatal spontaneous retroperitoneal bleeding in a 71-year-old woman with pneumonia and acute coronary syndrome. After receiving combination therapy with Lovenox (enoxaparin), aspirin, and Plavix for 5 days, she developed acute hemorrhagic shock and possible intra-abdominal compartment syndrome. Urgent computed tomography scan of the abdomen and pelvis was performed and showed a left retroperitoneal hematoma. The patient's condition continued lo deteriorate, which prompted emergent exploration. After evacuating 3 L of free blood from the peritoneal cavity, we managed to stabilize the patient. Our case of spontaneous retroperitoneal bleeding adds to the growing number of cases in which enoxaparin has been associated with severe bleeding. A high index of suspicion is necessary if the patient displays any of the signs and symptoms that suggest major hemorrhage. It appears that those at highest risk receive doses approaching 1 mg/kg subcutaneously every 12 hours, have renal impairment, are of advanced age, and receive concomitant medications that can affect hemostasis. On average, a retroperitoneal hematoma occurs within 5 days of therapy with enoxaparin. In high-risk patients, enoxaparin activity (anti-factor Xa) should be carefully monitored.
ACCESSION #
17074440

 

Related Articles

  • Dabigatran etexilate.  // Reactions Weekly;Aug2015, Vol. 1563 Issue 1, p73 

    The article presents a case study of an elderly patient who was diagnosed with retroperitoneal haematoma, haemorrhagic shock, and heart failure following an anticoagulation therapy with dabigatran etexilate for atrial fibrillation.

  • Life-Threatening Spontaneous Retroperitoneal Bleeding: A Rare Complication of Oral Anticoagulation. Casella, Roberto; Staedele, Harald; von Weymarn, Alexander; Stoffel, Flavio; Bongartz, Georg; Gasser, Thomas C. // Urologia Internationalis;Nov99, Vol. 63 Issue 4, p247 

    In a patient on oral anticoagulation with sudden onset of loin pain, the possibility of spontaneous bleeding in the retroperitoneum must be considered in the differential diagnosis of renal colic. This rare pathology can be life-threatening, and rapid diagnosis with ultrasound and computerized...

  • Anticoagulation Therapy for Secondary Stroke Prevention. Aguilar, Maria I.; Benavente, Oscar // Current Medical Literature: Stroke Review;2005, Vol. 9 Issue 3, p189 

    The article examines the effectiveness of anticoagulation therapy for secondary stroke prevention. There a two proven antithrombotic modalities for secondary stroke prevention namely, antiplatelet therapy and anticoagulation therapy. The major complication of anticoagulation therapy is bleeding,...

  • Drug-drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. Delaney, Joseph A.; Opatrny, Lucie; Brophy, James M.; Suissa, Samy // CMAJ: Canadian Medical Association Journal;8/14/2007, Vol. 177 Issue 4, p347 

    Background: Anticoagulants and antiplatelet drugs (e.g., warfarin, clopidogrel and acetylsalicylic acid) are key therapeutic agents in the treatment of cardiovascular diseases. However, drug-drug interactions may lead to a greatly increased risk of gastrointestinal bleeding when these drugs are...

  • Thromboprophylaxis for Central Venous Catheters in Cancer Patients. Segars, Kelly // Journal of Gynecologic Oncology Nursing;Fall2006, Vol. 16 Issue 3, p9 

    The use of prophylactic systemic anticoagulation (thromboprophylaxis) in cancer patients with central venous catheters (CVCs) is controversial in the clinical setting, as the results of the available research studies are varied and sometimes contradicting. This paper reviews the most recent...

  • Standardizing the management of heparin-induced thrombocytopenia. Fugate, Susan; Chiappe, Julia // American Journal of Health-System Pharmacy;2/15/2008, Vol. 65 Issue 4, p334 

    The article presents a case study on the implemented treatment protocol for management of patients who are suffering from heparin-induced thrombocytopenia (HIT). Medical records of patients who were suffering and suspected of HIT complication had undergone extensive evaluation to determine the...

  • Retroperitoneal haemorrhage during warfarin therapy. Tjun Tang; Lee, Justin; Dickinson, Richard // Journal of the Royal Society of Medicine;Jun2003, Vol. 96 Issue 6, p294 

    The article presents three medical case histories which show retroperitoneal bleeding into the psoas and iliacus muscles as one of the hemorrhagic complications of warfarin therapy. It should be noted that the therapeutic index of warfarin is narrow, and that anticoagulant control is easily...

  • Diffuse Alveolar Hemorrhage Associated with Edoxaban Therapy. Nitta, Kenichi; Imamura, Hiroshi; Yashio, Akihiro; Kashima, Satoko; Mochizuki, Katsunori // Case Reports in Critical Care;10/31/2016, p1 

    Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation...

  • UMBILICO-SYSTEMIC VEIN SHUNT FOR MASSIVE ESOPHAGEAL VEIN BLEEDING. Rachlin, Lillian // Vascular Surgery;Mar/Apr1972, Vol. 6 Issue 2, p93 

    Umbilico-systemic vein shunt for massive esophageal variceal bleeding offers a means of portal decompression that has a low operative risk and is minimally taxing to hepatic function. No anticoagulants or pumping mechanisms are required for most of these temporary extracorporeal shunts. They are...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics