Heparin/nadroparin calcium
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Lack of efficacy: case report A 64-year-old woman exhibited lack of efficacy while receiving treatment with heparin and nadroparin calcium [dosages not stated] for pulmonary embolism. The woman, who had been diagnosed with lobular breast carcinoma, was treated with neoadjuvant chemotherapy. She had an oncoplastic breast-conserving surgery. She was hospitalised 23 days after the surgery. She presented with nausea, abdominal pain, emesis and stool changes. Abdominal CT scan revealed a short bowel obstruction caused by a stenosis in the terminal ileum and ileocaecal junction. Thoracic CT angiography scan bilateral pulmonary embolism. On the next day, she underwent inferior vena cava filter (VCF) placement after which a right-sided hemicolectomy and creation of an end ileostomy were performed. During surgery, an abnormal tissue spot on the peritoneum was observed, which was suggestive of metastasis. Pathological examinations showed stenoses in the terminal ileum and the caecum, caused by multiple loci of metastases of lobular breast carcinoma and peritoneal carcinomatosis. A CT angiography showed a rectus sheath haematoma with continuation into the small pelvic cavity without active blush, while heparin was administrated. An IV heparin was changed to SC nadroparin calcium, and she was also initiated on piperacillin/tazobactam for an infected haematoma. Due to therapy-resistant pulmonary embolisms, recurrent glucose level swings, progressive renal insufficiency and the indication for palliative hormonal therapy were observed, and she was shifted to the internal medicine ward for further treatment. An abdominal CT scan 25 days postoperatively showed a gradual decrease of the rectus sheath haematoma with concomitant increase in free intraperitoneal fluid presumably following perforation of the haematoma and new abnormal findings as a consequence of further metastases and the paraneoplastic syndrome. Therefore, maximum conservative palliative treatment was started. But, she died shortly thereafter, and no autopsy was performed [cause of death not stated]. Meekel JP, et al. Small bowel obstruction caused by 18FDG-negative ileocecal metastasis of lobular breast carcinoma. Journal of Surgical Case Reports 2020: No. 7, Jul 2020. 803514184 Available from: URL: http://doi.org/10.1093/jscr/rjaa167
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Reactions 14 Nov 2020 No. 1830
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