Enoxaparin sodium/heparin
- PDF / 171,446 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 85 Downloads / 122 Views
1 S
Haemorrhage and rectal stump bleeding: 2 case reports In a case series, two women aged 25 years and 59 years were described, of whom one woman developed haemorrhage during anticoagulation therapy with heparin, whereas the other woman developed rectal stump bleeding during anticoagulation therapy with enoxaparin sodium and heparin [dosages, routes, times to reactions onsets and outcomes not stated]. Case 1. A 25-year-old woman, who had Crohn’s disease (CD), presented with the sudden onset of right-sided pleuritic chest pain. She was concomitantly receiving infliximab. Examinations after presentation showed right-sided pulmonary embolism (PE) and left atrial thrombus. She received anticoagulation with heparin bolus [unfractionated heparin], and was admitted. On hospital day 4, she developed sudden onset of diffuse abdominal-pain. A CT angiogram of the abdomen and pelvis demonstrated an acute superior mesenteric artery (SMA) occlusion. She then underwent exploratory laparotomy with superior mesenteric artery (SMA) arteriotomy and balloon embolectomy. She later underwent resection of the proximal segment of nonviable small bowel. Her bowel was placed back into continuity the following day and end ileostomy was created. Her postoperative course was complicated by haemorrhage, requiring discontinuation of her anticoagulation therapy. Over the next 3–5 days, she developed progressive fever and leukocytosis. Repeat imaging revealed a new SMA thrombosis. On returning to the operating room, the remaining ileum and jejunum were removed due to frank necrosis. Her postoperative course was complicated by recurrent episodes of severe haemorrhage, requiring cessation of anticoagulation. Additionally, she developed multiple abdominal abscesses requiring drainage. Heparin prophylaxis was then started, without any complication. One month post admission, she was transferred to an outside hospital for a possible small bowel transplant. Case 2: A 59-year-old woman, who had ulcerative colitis (UC), presented with right lower extremity pain and numbness for 24 hours. Her inflammatory bowel disease was previously managed with infliximab, but was self-discontinued at 6 months prior to the presentation. Two weeks previously, she was hospitalised for management of moderate-to-severe pancolitis. Her pain and bloody diarrhoea improved with pulsed steroids [specific drugs not stated] over 2 weeks, and she remained on enoxaparin sodium [enoxaparin] prophylaxis until discharge. Two days after discharge, she returned to the emergency room with numbness and pain in her right leg. Following investigations, right external iliac artery occlusion was observed. She underwent fasciotomies, followed by guillotine amputation. One week later, following stabilisation of the thrombotic event, a completion below-knee amputation was performed. She was transitioned from therapeutic heparin [unfractionated heparin] to enoxaparin sodium [enoxaparin], and remained on unspecified pulsed steroids postoperatively. She improved, however, she developed sepsis one we
Data Loading...
