Rectus Sheath Haematoma: Enoxaparin-Related Complication

Abstract

Rectus sheath haematoma, an uncommon complication related to subcutaneous administration of enoxaparin, has overall mortality of 4%. Possible mechanisms include unintended intramuscular injection of enoxaparin, and enhanced anticoagulant effect in the elderly and patients with increased bleeding risk. We describe the case of an 80 year-old female patient who was treated after a non-ST-elevated myocardial infarction, with enoxaparin, aspirin and clopidogrel. After a single dose of enoxaparin, the patient developed massive rectus sheath haematoma that was promptly diagnosed and was surgically managed. The patient recovered uneventfully. With incremented use of low-molecular weight heparins in the elderly, one may expect a growing number of bleeding complications.

A complication of enoxaparin injection

“…5 If these measures fail, patients should undergo surgical evacuation of the hematoma and ligation of bleeding vessels. 6 ■ TAKE-HOME MESSAGE Subcutaneous injections, especially of anticoagulants, into the abdominal wall can increase the risk of hematoma. Other risk factors are older age, female sex, and thin body habitus with less abdominal fat.…”