[Chest wall haemorrhage as a complication of anticoagulation treatment - a case study]

Low-molecular-weight heparins (LMWH) are a class of medication used as an anticoagulant. They belong amongst the so called direct anticoagulants. The effect on the coagulation cascade is mediated through the inactivation of anti-factor Xa. They are used in prophylaxis of thrombosis because of their lack of fibrinolytic effect. If the dosage is adequate, the effect on the bleeding time is minimal and thus monitoring is not necessary unlike in case of direct anticoagulants. Nevertheless, the monitoring is advisable in patients with renal insufficiency in whom the renal elimination of LMWH and their metabolites is reduced, hence they can cumulate in the organism and increase the risk of various bleeding complications. We present a case study of an 83-year-old patient with a massive subcutaneous haematoma caused by the cumulation of LMWH and with the subsequent huge defect of the chest wall treated with negative wound pressure therapy (Vacuum Assisted Closure - V.A.C.).