Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report

Abstract

Iliopsoas hematoma is an uncommon clinical entity that may develop in association with anticoagulation states, coagulopathies and hemodialysis, or anticoagulant therapy. Here, we report a case of unilateral iliopsoas hematoma in a 60-year-old man who received low-molecular-weight heparin for anticoagulation due to continuous veno-venous hemofiltration. The patient presented with fever and productive cough for 2 days. He received continuous veno-venous hemofiltration due to rising blood urea nitrogen (22.7 mmol/L; normal references: 3.2–7.1 mmol) and creatinine (1345 µmol/L; normal references: 53–106 µmol/L). Low-molecular-weight heparin (enoxaparin, 3500–5500 Da, 5–10 IU/kg/h) was delivered continuously by pumps for anticoagulation therapy. At day 12 post heparin treatment, the patient complained left back pain. Platelet count (243 × 109/L) was normal, but both activated partial thromboplastin time (67.5 s) and prothrombin time (17.3 s) were prolonged. Abdominal computed tomography scan revealed left iliopsoas swelling with an indistinct border. Low-molecular-weight heparin was discontinued. Anti-Xa was not monitored throughout the treatment. No improvement was seen, and 3 days later, the patient died after his family decided to terminate therapy. This case highlights the needs for careful anticoagulation as well as close monitoring, and particularly the use of anti-Xa to guide the treatment.

Spontaneous psoas haematoma from enhanced venous thromboembolism (VTE) prophylaxis for COVID-19 infection

“…[ 1 ] Unilateral spontaneous psoas haematomas have previously been described in the use of the standard prophylactic dose of LMWH. [ 2 ] These often present with non-specific symptoms, and hence, diagnosis can be difficult. [ 3 ]…”

Spontaneous Intramuscular Hematomas in Patients with Severe COVID-19 (Case Report)

“…Применение антикоагулянтов сопряжено с повышенным риском геморрагических осложнений, прежде всего, желудочно-кишечных (ЖК) кровотечений. Кроме того, у пациентов с COVID-19-инфекцией на сегодняшний день описаны случаи геморрагических осложнений в виде межмышечных гематом различной локализации; в большинстве наблюдений возникновение гематом связывают именно с проводимой антикоагулянтной терапией [5,6,[7][8][9][10]; в ряде случаев пациенты получали антикоагулянтную терапию в сочетании с дезагрегантами [11]. При отсутствии внешних признаков гематомы данное осложнение может проявляться неспецифическими симптомами, такими как анемия, дискомфорт и парестезии в поясничной области или на переднебоковой поверхности живота, появление боли в гипогастрии и, как крайний вариант, гемодинамической нестабильностью с явлениями гиповолемического (геморрагического) шока [5,[8][9][10][11][12][13].…”

Large Psoas Hematoma Complicating Anti-coagulant Therapy Poses a Diagnostic and Therapeutic Challenge

“…Spontaneous psoas haematoma in patients on anticoagulants is a rare phenomenon [1]. With a clinical symptomatology that is not very suggestive, it thus leads to a diagnostic problem.…”