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[Intraluminal ureteral hematoma complicating anticoagulant therapy]
Nobukazu Murosaki1, Hiroyuki Senoh, Masato Takemoto
1Department of Urology, Osaka Second Police Hospital.
Summary
A rare intraluminal ureteral hematoma occurred in a patient on anticoagulant therapy. Stopping anticoagulation and administering Vitamin K2 resolved the condition without transfusion, highlighting the need for frequent monitoring.
Area of Science:
- Urology
- Nephrology
- Pharmacology
Background:
- Intraluminal ureteral hematoma is a rare condition.
- Oral anticoagulant therapy is used for conditions like atrial fibrillation to prevent thrombolism.
Observation:
- A 65-year-old male on warfarin and bucolome presented with gross hematuria.
- Ultrasound revealed a mild wide renal pelvis; CT identified a right ureteral submucosal hematoma.
- The hematoma penetrated the ureteral mucosa, causing significant macrohematuria.
Findings:
- The patient's prothrombin time (PT) was excessively prolonged due to drug interaction between warfarin and bucolome.
- Anticoagulation was stopped, and intravenous Vitamin K2 was administered, normalizing PT.
- Despite a 1,200 ml hemorrhage, no blood transfusion was required.
Implications:
- This case highlights a rare complication of anticoagulant therapy.
- Close monitoring of PT-INR is crucial, especially with drug interactions like warfarin and bucolome.
- Conservative management with anticoagulation cessation and Vitamin K2 can be effective for ureteral hematoma.