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A retroperitoneal bleed induced by enoxaparin therapy
Martin Ernits1, Pradeep S Mohan, Louis G Fares
1Department of Surgery, Seton Hall University Surgical Residency Program at St. Francis Medical Center, Trenton, NJ, USA.
The American Surgeon
|July 1, 2005
Summary
Life-threatening retroperitoneal bleeding can occur with low-molecular-weight heparin (LMWH) therapy. Close monitoring of enoxaparin activity is crucial in high-risk patients to prevent severe hemorrhage.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Anticoagulation therapy is essential for managing conditions like acute coronary syndrome.
- Retroperitoneal bleeding is a rare but severe complication of anticoagulation.
- Low-molecular-weight heparin (LMWH) is commonly used, but severe bleeding events are infrequently reported.
Observation:
- A 71-year-old woman on enoxaparin, aspirin, and clopidogrel developed spontaneous retroperitoneal bleeding and hemorrhagic shock.
- Computed tomography revealed a large left retroperitoneal hematoma.
- Emergency surgical exploration evacuated 3 liters of blood, stabilizing the patient.
Findings:
- This case highlights a severe bleeding complication associated with enoxaparin (LMWH).
- Risk factors include high enoxaparin dosage, renal impairment, advanced age, and concomitant antiplatelet/anticoagulant use.
- Retroperitoneal hematomas with enoxaparin typically occur within 5 days of therapy initiation.
Implications:
- Clinicians should maintain a high index of suspicion for major hemorrhage in patients on enoxaparin.
- Careful monitoring of enoxaparin activity (anti-factor Xa) is recommended in high-risk individuals.
- This case underscores the importance of individualized risk assessment in anticoagulation management.