Enoxaparin-induced spontaneous massive retroperitoneal hematoma with fatal outcome

• Published in: The American journal of emergency medicine Vol. 32; no. 12; pp. 1559.e1 - 1559.e3
• Main Authors: Salemis, Nikolaos S., MD, PhD, FACS, Oikonomakis, Ioannis, MD, PhD, Lagoudianakis, Emanuel, MD, PhD, Boubousis, Georgios, MD, Tsakalakis, Christos, MD, Sourlas, Sotirios, MD, Gourgiotis, Stavros
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014; Elsevier Limited
• Subjects: Abdomen; Aged; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Atrial Fibrillation - drug therapy; Drug therapy; Emergency; Emergency medical care; Enoxaparin - adverse effects; Enoxaparin - therapeutic use; Fatal Outcome; Female; Heart attacks; Hematoma - chemically induced; Hematoma - diagnostic imaging; Humans; Mortality; Myocardial infarction; Retroperitoneal Space - diagnostic imaging; Thromboembolism; Tomography, X-Ray Computed
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.05.026

Spontaneous retroperitoneal hematoma (SRH) is a severe and potentially fatal complication of anticoagulation therapy. We describe a case of fatal spontaneous massive retroperitoneal hematoma in a female patient receiving bridging therapy with enoxaparin for atrial fibrillation. Physicians should be cautious when prescribing enoxaparin in elderly patients, in patients with impaired renal function, and in patients receiving concomitant oral anticoagulants. Emergency physicians should always consider SRH in the differential diagnosis in patients under enoxaparin therapy presenting with abdominal pain. Computed tomographic scan is the imaging modality of choice for evaluating SRH. Early diagnosis and aggressive treatment are of paramount importance as SRH is associated with high mortality and morbidity rates.