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Enoxaparin-sodium/rivaroxaban/warfarin Multiple site bleeding, haematomas and haematuria: 10 case reports

In a retrospective record review of 53 patients (started anticoagulation therapy from September 2013 to February 2020), ten patients (5 men and 5 women) aged 45–78 years were described, who developed intracranial haemorrhage (ICH), acute tumour bed haematoma, subconjunctival haemorrhage, subcapsular renal haematoma, subacute subdural haematoma, haematuria, gastrointestinal (GI) bleeding or superficial surgical wound bleeding following anticoagulation therapy with enoxaparin sodium, rivaroxaban or warfarin [time to reactions onsets not stated; not all routes, dosages and outcomes stated]. The patients, who had glioblastoma, atypical meningioma, functioning pituitary tumour (gonadotroph adenoma), vestibular schwannoma, ruptured intracranial aneurysm or pial arteriovenous fistula, underwent craniotomy. Concurrently, two of these patients had thrombocytopenia or transient acute renal failure. The patients started receiving prophylactic anticoagulation therapy with SC enoxaparin sodium 40mg daily after surgery. Subsequently, the patients developed VTE. Enoxaparin sodium was changed to warfarin (9 patients) or oral rivaroxaban (1 patient) on post-operative day 7-21 for long-term treatment. During the follow-up, the patients developed ICH and acute tumour bed haematoma (3 patients), subconjunctival haemorrhage (1 patient), subcapsular renal haematoma (1 patient), ICH and subacute subdural haematoma (1 patient), haematuria (2 patients), GI bleeding (1 patient) and superficial surgical wound bleeding (1 patient). Two of these 10 patients died due to ICH and acute tumour bed haematoma. de Melo Junior JO, et al. Therapeutic anticoagulation for venous thromboembolism after recent brain surgery: Evaluating the risk of intracranial hemorrhage. Clinical Neurology and Neurosurgery 197: Oct 2020. Available from: URL: http://doi.org/10.1016/j.clineuro.2020.106202

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Reactions 3 Oct 2020 No. 1824