JC Gibson1* KA Muhiddin2, N Cozens3
1*Babington Hospital, Derby Road, Belper, Derbyshire, DE56 1WH
2Derby City General Hospital 3Derbyshire Royal Infirmary
SMJ 2007 52(4): 53
A 94-year-old man
was treated for seven days with enoxaparin (100mg od) for suspected deep venous
thrombosis (DVT) following elective right total hip replacement.
He complained of abdominal pain. Bruising
was noted overlying his left flank (Turner’s Sign; see clinical picture).
He had a tender left iliac fossa mass.
Urgent ultrasound scan (US/S) and subsequent Computerised Tomography (CT)
Scan revealed a 16 x 11 x 6 cm abdominal wall haematoma.
Haemoglobin dropped to 7.6 d/dl. He
remained haemo-dynamically stable with conservative management.
Low molecular
weight heparins (LMWH) have many advantages over conventional unfractionated
heparin (UFH). Their
pharmacokinetics are more predictable, they have longer plasma half-life, bind
less to the endothelium and therefore higher bioavailability levels.
They provide effective anticoagulation after subcutaneous administration
without the need for laboratory monitoring and therefore potentially reduce
costs of care. Additionally, they
inhibit platelet function less and therefore have a lower incidence of
substantial bleeding.1
However, bleeding
complications can still occur with LMWH, a serious one being abdominal wall
haematoma. It is important that
clinicians maintain a high index of suspicion, especially in elderly patients
and those receiving significant concomitant therapy (e.g. aspirin, warfarin), of
abdominal wall haematoma as a potentially life threatening complication of
enoxaparin therapy. As a
precaution, reduction in enoxaparin dose may be prudent in elderly patients who
are also on other medication that may affect coagulation.
Reference
1Chan-Tack KM. Fatal Spontaneous Retroperitoneal Hematoma Secondary to Enoxaparin. Southern Medical Journal. 2003 Jan; 96(1): 58-60.