Spontaneous rectus sheath hematoma associated with low dose of acetylsalicylic acid

Watanabe, André Luís Conde; Pedroso, Diogo Borges; Jorge, Fernando; Cunha, Túlio Marcos Rodrigues da; Soares, Aloísio Fernando

doi:10.1590/s0102-67202014000100020

Cited by 4 publications

(4 citation statements)

References 9 publications

(24 reference statements)

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“…Bilateral rectus sheath haematoma is an even rarer occurrence with few documented cases in literature [12–14]. Rectus sheath haematoma is commonly seen in women more than men and specially in their 6th to 7th decades of life [15]. The risk of developing rectus sheath haematoma is greater when having a background history of trauma, straining, coughing, pregnancy and abdominal surgery [16].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, rectus sheath haematomas have also been documented complicating dengue viral fever [14, 17]. Though conservative management is adequate in most circumstances with the cessation of anticoagulation, when complicated with haemodynamic instability supportive care coupled with blood transfusion may become necessary [11, 15]. Thus having awareness and maintaining a high index of suspicion in appropriate clinical circumstances is paramount for the early and accurate diagnosis of rectus sheath haematoma.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report

et al. 2017

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BackgroundThe management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken. The use and continuation of warfarin in dengue virus infection is one such example.Case presentationWe report a 65 year old South Asian female who presented with dengue fever. She had a history bronchial asthma, a prior abdominal surgery, and was on warfarin and maintained a therapeutically appropriate internationalized normalized ratio for a mechanical aortic valve replacement. Though preemptive decision to stop warfarin was taken with decreasing platelet counts, her clinical course was complicated with the development of bilateral rectus sheath haematoma’s requiring resuscitation with blood transfusions.ConclusionThough management of dengue viral fever has seen drastic evolution with recent updated guidance, clinical scenarios seen in the course of the illness still pose challenges to the managing physician. The need to continue obligatory anticoagulation which may seem counterintuitive during a complex disease such as dengue virus infection must be considered after understanding the potential risks versus that of its benefits. Though case by case decisions maybe warranted, a clear protocol would be very helpful in making clinical decisions, as the correct preemptive decision may potentially avert catastrophic and unpredictable bleeding events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report

et al. 2017

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“…Major muscular hematomas have been very rarely associated with antiplatelet agents, 8.8% in the present study and 4% in our previous study [6], irrespective of location. Indeed, only case-reports of patients with major muscular hematoma associated with antiplatelet agents were found [16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort

Bouget¹,

Huet²,

Roy³

et al. 2021

Thrombosis Research

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Background: There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants.Objective: To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality.Patients and Methods: Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated. Clinical and biological data, therapeutic management of the bleeding event, and in-hospital mortality were collected from the medical records and compared across five groups of hematoma locations.Potential confounders were taken in account using a multivariate binomial regression model.Results: Three hundred and seventy-five patients were included (mean age = 81.4 years): 271 were exposed to vitamin K antagonists, 58 to parenteral anticoagulants (heparin, LMWH, fondaparinux), 33 to antiplatelets, and 13 to direct oral anticoagulants. The muscular hematomas were located in the lower limbs (n = 198), the rectus sheath (n = 71), the iliopsoas (n = 45), the upper limbs (n = 33), or elsewhere (n = 28). Reversal therapy was prescribed for 48.5% of patients, red cell transfusions for 63.6%, surgery for 12.3% and embolization for 3.5%. For 84% of patients, hospitalization was required, with a median length of stay of 10 days. Overall, in-hospital mortality was 8.5%. Reversal therapy, the need for intensive care and mortality were significantly more frequent among patients with iliopsoas hematomas. The independent predictors of in-hospital mortality were: decrease in mean arterial pressure (RR = 1.84), decrease in hemoglobin level (RR = 1.37) and the iliopsoas location (RR = 3.06). Conclusion:Frail elderly patients with major muscular hematomas linked to antithrombotic agents risk substantial morbidity and in-hospital mortality. The iliopsoas location was the most life-threatening bleeding site. Close observation of this population is warranted to ensure better outcomes.

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“…Quando não é possível identificar uma causa traumática, designa-se o HRA como espontâneo. 16 Nestes, consideram-se os paroxismos de tosse como o principal factor precipitante e a anticoagulação o principal factor de risco 6,9 com 69% -80% dos doentes com o diagnóstico de HRA espontâneo a estarem hipocoagulados. 6,17 Um estudo realizado por Cherry et al 14 em 126 casos de HRA espontâneo, 70% dos doentes estavam hipocoagulados e no estudo de A. Smithson et al 13 foram identificados 24 casos de HRA, dos quais 87,5% estavam a receber terapêutica anticoagulante e em 70,8% identificou-se a tosse como factor precipitante.…”

Section: Epidemiologia E Etiologiaunclassified

Hematoma do Recto Abdominal numa Enfermaria Médica: Série de Casos

Prayce

Furtado

Dias

2021

RPMI

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Introdução: O hematoma do recto abdominal é uma entidade rara e causa incomum de dor abdominal. Apesar de habitualmente benigno, é potencialmente fatal, sobretudo em doentes idosos e hipocoagulados. Pretendemos estudar a ocorrência e apresentação clínica desta entidade, focando a sua relação com a terapêutica hipocoagulante. Material e Métodos: Análise retrospetiva de uma série de casos observados num serviço de Medicina de um hospital terciário universitário e revisão da literatura. Foram incluídos doentes com diagnóstico de hematoma do recto abdominal de 2010 a 2018. Resultados: No período de estudo foram identificados 9 casos em 14 730 admissões, com idade média de 78 ± 9 anos, 6 do sexo feminino. Todos apresentaram hematoma do recto abdominal espontâneo. Quarenta e quatro por cento foram graves, segundo a classificação de Berná e a mortalidade foi de 11%. A apresentação mais frequente foi dor abdominal com queda de hemoglobina (média de 3,7 ± 1,8 g/ dL) e confirmou-se o diagnóstico por tomografia computorizada. Todos os doentes estavam hipocoagulados. Os doentes sob dicumarínicos apresentaram INR supra-terapêutico (média 6,0 ± 2,6) e um factor precipitante (tosse), ao contrário dos doentes sob heparina de baixo peso molecular. Foi necessário reverter a anticoagulação em 6 casos. Cinco doentes tiveram alta hipocoagulados, sem recorrência de hematoma do recto abdominal. Discussão/Conclusão: O hematoma do recto abdominal deve ser considerado no diagnóstico diferencial de dor abdominal em doentes anticoagulados. Apesar de ser uma complicação rara da terapêutica hipocoagulante, pode resultar num desfecho fatal. A administração correcta da heparina de baixo peso molecular, o controlo rigoroso do INR e a elevada suspeita clínica poderão contribuir para uma menor morbi-mortalidade.

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Spontaneous rectus sheath hematoma associated with low dose of acetylsalicylic acid

Cited by 4 publications

References 9 publications

Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report

Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort

Hematoma do Recto Abdominal numa Enfermaria Médica: Série de Casos

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