Retroperitoneal Hematoma Following Enoxaparin Treatment in an Elderly Woman
| Autor: | Björn Dario Franjić, Ivo Lovričević, Drago De Syo, Milan Vukelić, Narcis Hudorović, Mario Ledinsky, Tomislav Krpan |
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| Jazyk: | chorvatština |
| Rok vydání: | 2007 |
| Předmět: | |
| Zdroj: | Acta clinica Croatica Volume 46 Issue 4 |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | Retroperitonealni hematom može nastati uslijed traume, no također može nastati kao posljedica rupture aneurizme aorte ili zdjelične arterije, tumora ili antikoagulantne terapije. Retroperitonealno krvarenje opasno za život rijetka je komplikacija antikoagulantne terapije. Enoksaparin je heparin niske molekularne težine koji ima nekoliko prednosti u odnosu na nefrakcionirani heparin. Ipak, upotreba enoksaparina nije bez rizika te može dovesti do potencijalno smrtonosnog masivnog retroperitonealnog krvarenja. Prikazan je slučaj 76 godina stare bolesnice hospitalizirane zbog akutnog koronarnog sindroma, kod koje se razvio velik retroperitonealni hematom 5. dana terapije enoksaparinom. Upotreba enoksaparina u akutnom koronarnom sindromu, kao i u standardnoj tromboprofilaksi porasla je u zadnjem desetljeću, što može dovesti do povećane učestalosti retroperitonealnog krvarenja u kliničkom okruženju. Ova činjenica zahtijeva da liječnici budu krajnje oprezni i spremni na traženje simptoma i znakova retroperitonealnog krvarenja, te valja identificati skupine bolesnika s povišenim rizikom kod kojih je neophodno pažljivo praćenje antikoagulantne terapije. Liječenje bolesnika s retroperitonealnim hematomom mora se odvijati u jedinici intenzivnog liječenja. Enoksaparin se mora isključiti iz terapije, protamin se ordinira ovisno o vremenu proteklom od zadnje doze enoksaparina, svježe smrznuta plazma i koncentrat eritrocita se daju prema potrebi, a kirurško liječenje je potrebno kod bolesnika koji se ne stabiliziraju uz konzervativno liječenje. Retroperitoneal hematoma may occur as a result of trauma, but also from rupture of arterial aneurysms (aortic or iliac), surgical complications, tumors and anticoagulation therapy. A life threatening retroperitoneal hemorrhage is an infrequent complication of anticoagulation treatment. Enoxaparin is a low-molecular-weight heparin with several advantages over unfractionated heparin. Nevertheless, enoxaparin use is not without risk and severe retroperitoneal bleeding may occur following its use, with a potentially fatal outcome. The case of a 76-year-old woman hospitalized for acute coronary syndrome who developed a large retroperitoneal hematoma on day 5 of enoxaparin therapy is presented. The use of enoxaparin in the acute coronary syndrome as well as in standard thromboprophylaxis has increased over the past decade, which may lead to an increased occurrence of retroperitoneal bleeding in clinical settings. Therefore, physicians should be extremely observant for symptoms and signs of retroperitoneal hemorrhage, and identification of a group of high-risk patients who require close anticoagulation monitoring is mandatory. The treatment of patients with retroperitoneal hematoma should be provided in the intensive care unit setting. Enoxaparin must be discontinued; protamine may be administered depending on the time elapsed from the last enoxaparin dose; fresh frozen plasma and packed red blood cells should be administered if necessary; and surgical intervention may be required if the patient fails to stabilize. |
| Databáze: | OpenAIRE |
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