Dalteparin-associated catastrophic retroperitoneal hematoma successfully treated with recombinant factor VIIa

Low-molecular-weight heparins (LMWHs) have been widely used in many clinical settings. LMWH-associated spontaneous retroperitoneal hematoma (SRH) has been reported mostly in patients treated with enoxaparin. We here present a 76-year-old man with renal insufficiency treated with dalteparin for acute myocardial infarction, who developed catastrophic SRH with intra-abdominal hypertension (IAH) and hemothorax. Because of the high risk of surgical intervention, we performed ultrasound-guided abdominal paracentesis and thoracentesis to relieve IAH and respiratory distress. Vigorous supportive care with massive blood product transfusions was given to stabilize his hemodynamics. Finally, the bleeding was stopped with a powerful hemostatic agent, recombinant factor VIIa. Surgical evacuation of a 3,600 mL blood clot was performed successfully 1 month later.