Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: A case report

被引:22
作者
Daliakopoulos S.I. [1 ,3 ]
Bairaktaris A. [1 ,3 ]
Papadimitriou D. [2 ]
Pappas P. [2 ]
机构
[1] Herz- und Diabeteszentrum Nordrhein, Westfalen, Bad Oeynhausen, Georgstrasse
[2] Department of Vascular and Endovascular Surgery, Thessaloniki
[3] Universitätsklinikum der Ruhr-Universität, Bochum
关键词
International Normalize Ratio; Abdominal Aortic Aneurysm; Transient Ischemic Attack; Retroperitoneal Hematoma; Retroperitoneal Hemorrhage;
D O I
10.1186/1752-1947-2-162
中图分类号
学科分类号
摘要
Introduction: Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge. Case presentation: We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4), which was treated conservatively. Conclusion: Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome. © 2008 Daliakopoulos et al; licensee BioMed Central Ltd.
引用
收藏
相关论文
共 26 条
[1]
Juergens C.P., Semsarian C., Keech A.C., Beller E.M., Harris P.J., Hemorrhagic complications of intravenous heparin use, Am J Cardiol, 80, pp. 150-154, (1997)
[2]
Mant M.J., O'Brien B.D., Thong K.L., Hammond G.W., Birtwhistle R.V., Grace M.G., Haemorrhagic complications of heparin therapy, Lancet, 1, pp. 1133-1135, (1977)
[3]
Leizorovicz A., Comparison of the efficacy and safety of low molecular weight heparins and unfractionated heparin in the initial treatment of deep venous thrombosis: An updated meta-analysis, Drugs, 52, SUPPL. 7, pp. 30-37, (1996)
[4]
Montoya J.P., Pokala N., Melde S.L., Retroperitoneal hematoma and enoxaparin, Ann Intern Med, 131, pp. 796-797, (1999)
[5]
Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia, N Engl J Med, 333, pp. 5-10, (1995)
[6]
Singer E., Daniel M.D., Chair Albers W., Gregory M.D., Dalen E., James M.D., Go S., Alan M.D., Halperin L., Jonathan M.D., Manning J., Warren M.D., Antithrombotic therapy in atrial fibrillation: The Seventh ACCP Conference on Antithrombotic and Thrombotic Therapy, Chest, 126, (2004)
[7]
Hylek E.M., Chang Y.C., Skates S.J., Hughes R.A., Singer D.E., Prospective study of outcomes of ambulatory patients with excessive Warfarin anticoagulation, Arch Inter Med, 160, pp. 1612-1617, (2000)
[8]
Panetta T., Sclafani S.J., Goldstein A.S., Phillips T.F., Shaftan G.W., Percutaneous Transcatheter embolization for massive bleeding from pelvic fractures, J Trauma, 25, pp. 1021-1029, (1985)
[9]
Illescas F.F., Baker M.E., McCann R., Cohan R.H., Silverman P.M., Dunnick N.R., CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography, AJR Am J Roentgenol, 146, pp. 1289-1292, (1986)
[10]
Sclafani Salvatore J.A., Florence Lauren O., Phillips Thomas F., Scalea Thomas M., Glanz S., Goldstein Alan S., Duncan Albert O., Shaftan Gerald W., Lumbar arterial injury: Radiologic diagnosis and management, Radiology, 165, pp. 709-714, (1987)