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Thrombotic Risk after a Major Bleeding During Anticoagulation: A Clinical Case
Serenella Conti1, Marco Ciuffetti2, Maria Cristina Vedovati3
1Division of Cardiology-UTIC-Cardiovascular Rehabilitation, Spoleto Hospital, USL Umbria 2, Spoleto, Italy.
Journal of Cardiovascular Echography
|May 4, 2017
Summary
An elderly woman on warfarin developed a retroperitoneal hematoma after trauma. Anticoagulation reversal with prothrombin complex concentrates (PCCs) led to pulmonary embolism, highlighting the thrombotic risk of PCCs.
Area of Science:
- Medicine
- Radiology
- Hematology
Background:
- Warfarin is commonly prescribed for atrial fibrillation.
- Retroperitoneal hematomas can occur after minor trauma, especially in patients on anticoagulation.
- Accurate diagnosis of retroperitoneal hematoma requires advanced imaging like CT angiography.
Observation:
- An 81-year-old female on warfarin presented with abdominal pain post-trauma.
- CT angiography revealed a retroperitoneal hematoma with elevated international normalized ratio.
- Initial anticoagulation reversal with prothrombin complex concentrates (PCCs) was followed by pulmonary embolism.
Findings:
- PCCs rapidly reversed anticoagulation but posed a thrombotic risk.
- Enoxaparin and subsequent apixaban management led to clinical improvement and hematoma reduction.
- This case highlights the delicate balance between managing bleeding and preventing thrombosis during anticoagulation reversal.
Implications:
- Careful consideration of thrombotic risk is crucial when using PCCs for anticoagulation reversal.
- Alternative anticoagulation strategies may be necessary in high-risk patients.
- Further research into optimal anticoagulation reversal protocols is warranted.
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