Enoxaparin sodium
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Gastrointestinal bleeding following mucosal biopsy: case report A 32-year-old woman developed gastrointestinal bleeding following a mucosal biopsy while receiving enoxaparin sodium [Lovenox; time to reaction onset not stated]. The woman was receiving SC enoxaparin sodium 50mg twice a day, for a right ovarian vein thrombosis. After 1 week of nausea, emesis, epigastric pain and weight loss, an upper endoscopy was performed. This revealed a diffuse gastric erythema, prompting a mucosal biopsy. About 12 hours after the procedure, she experienced haematemesis and developed tachycardia and hypotension. Enoxaparin sodium was discontinued and the woman was transferred to ICU. Her haemoglobin level decreased from 12.6 g/dL to 6.3 g/dL over 33 hours. After fluid resuscitation and administration of 6 units of packed RBCs, her haemoglobin level increased to 10.4 g/dL and her vital signs normalised. Another upper endoscopy, performed 48 hours after the initial procedure, showed a clot at the mucosal biopsy site that required insertion of a haemastatic clip. Author comment: "[E]noxaparin may pose an increased risk of gastrointestinal bleeding in the setting of endoscopy with mucosal biopsy." Murie J, et al. Hemodynamically Significant Gastrointestinal Bleeding after Mucosal Biopsy During Upper Endoscopy in an Anticoagulated Patient. 75th Annual Scientific Meeting of the American College of Gastroenterology : abstr. P806, 15 Oct 2010. Available from: URL: http://www.acg.gi.org 803042909 USA
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Reactions 30 Oct 2010 No. 1325
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