We present a patient with chronic renal insufficiency who developed a massive posttraumatic abdominal wall hematoma after a single therapeutic dose of enoxaparin administered during workup of chest pain. Surgical evacuation of the hematoma was required to control life-threatening hemorrhage. Low-molecular-weight heparin use is not without risk and mandates appropriate indication and accurate dosing. Bleeding can occur at any site during heparin therapy, and abdominal wall hematoma should be considered as a source after traumatic injury.
Get full access to this article
View all access options for this article.
References
1.
HirshJ., WarkentinT.E., RaschkerL.Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety.Chest1998; 114(5 Suppl): 489–500.
2.
HirshJ., RaschkeR.Heparin and low-molecular-weight heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest2004; 126: 188–203.
3.
HarrisonL., McGinnisJ., CrowtherM.Assessment of outpatient treatment of deep-venous thrombosis with low-molecular-weight heparin.Arch Intern Med1998; 158: 2001–10.
4.
GouldM.K., DembitzerA.D., SandersG.D.Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis, a meta-analysis of randomized controlled trials.Ann Intern Med1999; 130: 800–25.
5.
NobleS., SpencerC.M.Enoxaparin: a review of its clinical potential in the management of coronary artery disease.Drugs1998; 56: 259–66.
6.
LandefeldC.S., McGuireE., RosenblattM.W.A bleeding risk index for estimating the probability of major bleeding in hospitalized patients starting anticoagulant therapy.Am J Med1990; 89: 569–77.
7.
NieuwenhuisH.K., AlbadaJ., BangaJ.D.Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin.Blood1991; 78: 2337–46.
8.
BergquistD., BornG.U., ArforsK.E.Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep venous thrombosis.Br J Surg1997; 84: 1099–103.
9.
NobleS., SpencerC.M.Enoxaparin: a reappraisal of its pharmacology and clinical applications in the prevention and treatment of thromboembolic disease.Drugs1995; 49: 388–400.
10.
BoneuB., deMoerlooseP.How and when to monitor a patient treated with low molecular weight heparin.Semin Thromb Hemost2001; 27: 519–22.
11.
FarooqV., HegartyJ., ChandrasekarT.Serious adverse incidents with the usage of low molecular weight heparins in patients with chronic kidney disease.Am J Kidney Dis2004; 43: 531–7.
12.
SanderinkG.M., GuimartC.G., OzouxM.L.Pharmacokinetics and pharmacodynamics of the prophylactic dose of enoxaparin once daily over 4 days in patients with renal impairment.Thromb Res2002; 105: 225–31.
13.
DuToitD.F., MaritzJ., LoxtonA.J.Rectus sheath hematoma, a complication of anticoagulant therapy.S Afr Med J1983; 63: 902–4.
