Enoxaparin sodium
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Retroperitoneal haemorrhage in an elderly patient: case report A 73-year-old woman developed retroperitoneal haemorrhage during treatment with enoxaparin sodium. Following a right hip replacement revision for recurrent dislocations, the woman was hospitalised under the impression of wound infection and deep vein thrombosis. At the time of admission her vital signs were stable and her coagulation data were unremarkable so she received thromboprophylaxis with SC enoxaparin sodium 30mg/12 hours. On day 4 of admission, she developed sudden onset left flank pain and cold sweating. Sonography showed fluid collection at the left retroperitoneum. She had an HR of 102 beats/minute, and her BP had dropped to 53/33mm Hg. Enoxaparin sodium was immediately discontinued, and the woman was transferred to the ICU. She received fresh frozen plasma, packed red blood cells and fluid resuscitation; however, her haemodynamic status remained unstable (BP 79/56mm Hg and HR 121 beats/minute). Emergent CT scan demonstrated a large haematoma at her left retroperitoneum, and subsequent angiography showed contrast extravasation from the left lumbar arteries and internal iliac artery branches. She underwent transcatheter arterial embolisation with placement of absorbable gelatin sterile sponges. Subsequent angiogram confirmed cessation of bleeding, and she became haemodynamically stable. However, she underwent another angiogram 2 days later, because of an unexplained decrease in her haemoglobin level, which showed extravasation from a different lumbar artery. She underwent further embolisation. The remainder of her hospital course was unremarkable, and she was discharged 3 weeks later. Sun P-L, et al. Retroperitoneal hemorrhage caused by enoxaparin-induced spontaneous lumbar artery bleeding and treated by transcatheter arterial embolization: A case report. Cases Journal 2: Dec 2009. Available from: URL: 803010624 http://dx.doi.org/10.1186/1757-1626-2-9375 - Taiwan
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Reactions 17 Apr 2010 No. 1297
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