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Rectus sheath hematoma complicating low-molecular weight heparin therapy
P J Denard1, J C Fetter, L R Zacharski
1Department of Orthopedics, Oregon Health Sciences University, Portland, OR, USA.
International Journal of Laboratory Hematology
|May 4, 2007
Summary
Rectus sheath hematoma (RSH) is a rare complication of low-molecular weight heparin (LMWH) therapy. Patients with renal insufficiency, advanced age, and cough are at higher risk for this serious bleeding event.
Area of Science:
- Internal Medicine
- Pharmacology
- Nephrology
Background:
- Rectus sheath hematoma (RSH) is an uncommon but serious bleeding complication of anticoagulant therapy.
- Little attention has been given to RSH in the medical literature.
- Low-molecular weight heparin (LMWH) is a common anticoagulant used in clinical practice.
Observation:
- A review of six cases of RSH was conducted.
- All six patients were receiving LMWH therapy.
- Five patients had a creatinine clearance of 40 ml/min or less and presented with cough.
Findings:
- RSH complicating LMWH therapy may present as a clinical syndrome.
- This syndrome includes sudden abdominal pain in patients with renal insufficiency, advanced age, and abdominal straining (e.g., cough).
- Two elderly patients (90 and 92 years old) experienced the most severe outcomes.
Implications:
- Risk of RSH in LMWH patients may be reduced by assessing renal function and monitoring heparin levels, especially with creatinine clearance ≤ 40 ml/min.
- Dose adjustment, avoidance of abdominal strain (e.g., treating cough), and proper injection technique can mitigate risks.
- Elderly patients are identified as a particularly high-risk group for RSH.
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