Fatal retroperitoneal hematoma after enoxaparin administration in a patient with paroxysmal atrial flutter

Abstract

A 63-year-old African-American woman with a 24-hour history of severe, nonexertional chest pain and new-onset paroxysmal atrial flutter without ST-segment elevation was treated with enoxaparin and subsequently died of a fatal spontaneous retroperitoneal hematoma.

Spontaneous Retroperitoneal Hematoma: Etiology, Characteristics, Management, and Outcome

“…Previous accounts consist mostly of small case-based series or single case reports that usually highlight the relationship between SRH and the use of antiplatelet or anticoagulant therapies (1)(2)(3)(4). In a similar fashion, current management recommendations are often anecdotal or based on a limited number of patients (5).…”

Clinical spectrum of patients with spontaneous retroperitoneal hematomas

“…SRH is a complication of anticoagulant therapy, [8][9][10][11] although cases have also been reported in NAC subjects. 1,2 Few series have analyzed this entity deeply.…”

Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty

“…Spontaneous retroperitoneal hematomas have been described after warfarin and heparin anticoagulation [5,6,10,11,[13][14][15]. Despite the low incidence of severe Fig.…”

“…Despite the low incidence of severe Fig. 1 The hematoma involving the anterior and central parts of the right lobe of the liver hemorrhage associated with LMWH use, these drugs carry the risk of potentially deadly adverse effects and rare, fatal cases of retroperitoneal hematomas have been observed following anticoagulation with LMWHs [5,13,14].…”

“…LMWHs, including nadroparin, have proven to be as safe and effective as unfractionated heparin for the prophylaxis of DVT in abdominal, hip and knee replacement surgery, with added advantages of decreased laboratory test value monitoring and outpatient drug administration [5,7,13].…”