Bilateral adrenal hemorrhage: a complication of prophylactic anticoagulation

The following case report presents a rare complication, bilateral adrenal hemorrhage, following low dose heparin prophylaxis for deep vein thrombosis in a 59-year-old total hip replacement patient. Symptoms associated with adrenal hemorrhage included nausea, vomiting, epigastric pain, increased temperature and white blood-cell count, and a drop in the hematocrit. At no time either pre- or postoperatively were hematological studies abnormal.Adrenal hemorrhage has been documented following therapeutic doses of heparin but is exceedingly rare following low doses of the drug. It has rarely been diagnosed before death occurred. It is concluded that use of low doses of heparin for prevention of deep vein thrombosis is of limited efficacy in patients undergoing total hip replacement surgery and its routine use is therefore not recommended.