Enoxaparin-associated retroperitoneal bleeding in two patients with renal insufficiency

Two patients with chronic kidney disease experienced a major bleeding event, retroperitoneal hematoma, requiring a blood transfusion after the administration of enoxaparin. The first patient was a 61-year-old Caucasian woman with multiple comorbidities, including chronic kidney disease stage 4. She received subcutaneous enoxaparin 45 mg every 12 hours, along with antiplatelet agents. On the seventh day, she developed a large retroperitoneal hematoma and her hematocrit had decreased, requiring a transfusion of packed red blood cells. The second patient was a 74-year-old, obese Caucasian woman with multiple comorbidities, including chronic kidney disease stage 2-3 and atrial fibrillation. She was given enoxaparin 120 mg every 12 hours, along with warfarin and aspirin to prevent embolization. She developed a large retroperitoneal hematoma and died despite vigorous supportive care. Enoxaparin should be administered with great caution in patients with chronic kidney disease, especially if antiplatelet agents or other anticoagulants are administered concomitantly.