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Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation

We report a case of anticoagulation therapy complicated by a non-traumatic rectus sheath hematoma (RSH). RSH is a relatively rare occurrence caused by bleeding into the rectus sheath following the rupture of the superior and inferior epigastric vessels combined with a primary tear of the rectus musc...

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Autores principales: Hideyama, Takuto, Watanabe, Eri, Ido, Nobuhiro, Terashi, Hiroo, Aizawa, Hitoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598347/
https://www.ncbi.nlm.nih.gov/pubmed/37885548
http://dx.doi.org/10.7759/cureus.45876
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author Hideyama, Takuto
Watanabe, Eri
Ido, Nobuhiro
Terashi, Hiroo
Aizawa, Hitoshi
author_facet Hideyama, Takuto
Watanabe, Eri
Ido, Nobuhiro
Terashi, Hiroo
Aizawa, Hitoshi
author_sort Hideyama, Takuto
collection PubMed
description We report a case of anticoagulation therapy complicated by a non-traumatic rectus sheath hematoma (RSH). RSH is a relatively rare occurrence caused by bleeding into the rectus sheath following the rupture of the superior and inferior epigastric vessels combined with a primary tear of the rectus muscle fibers. Herein, we report a rare presentation of RSH in a 73-year-old man taking the direct oral anticoagulant (DOAC) apixaban orally. The patient presented with sudden right abdominal pain after a severe cough, which worsened with cough and movement. The Fothergill and Carnett signs were positive. The platelet count, renal function test, and the prothrombin time/international normalized ratio were within the normal range. The activated partial thromboplastin time was 40.0 s, slightly longer than normal. Computed tomography (CT) of the abdomen and pelvis showed RSH, and DOAC therapy was temporarily discontinued. Subsequently, RSH resolution was confirmed via CT four weeks after the onset. DOACs are safer and more efficacious than warfarin for patients with non-valvular atrial fibrillation. However, RSH is a potential complication of anticoagulant therapy. This case report demonstrates that RSH should be considered in the differential diagnosis of sudden-onset abdominal pain and mass in patients on DOACs.
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spelling pubmed-105983472023-10-26 Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation Hideyama, Takuto Watanabe, Eri Ido, Nobuhiro Terashi, Hiroo Aizawa, Hitoshi Cureus Family/General Practice We report a case of anticoagulation therapy complicated by a non-traumatic rectus sheath hematoma (RSH). RSH is a relatively rare occurrence caused by bleeding into the rectus sheath following the rupture of the superior and inferior epigastric vessels combined with a primary tear of the rectus muscle fibers. Herein, we report a rare presentation of RSH in a 73-year-old man taking the direct oral anticoagulant (DOAC) apixaban orally. The patient presented with sudden right abdominal pain after a severe cough, which worsened with cough and movement. The Fothergill and Carnett signs were positive. The platelet count, renal function test, and the prothrombin time/international normalized ratio were within the normal range. The activated partial thromboplastin time was 40.0 s, slightly longer than normal. Computed tomography (CT) of the abdomen and pelvis showed RSH, and DOAC therapy was temporarily discontinued. Subsequently, RSH resolution was confirmed via CT four weeks after the onset. DOACs are safer and more efficacious than warfarin for patients with non-valvular atrial fibrillation. However, RSH is a potential complication of anticoagulant therapy. This case report demonstrates that RSH should be considered in the differential diagnosis of sudden-onset abdominal pain and mass in patients on DOACs. Cureus 2023-09-24 /pmc/articles/PMC10598347/ /pubmed/37885548 http://dx.doi.org/10.7759/cureus.45876 Text en Copyright © 2023, Hideyama et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Family/General Practice
Hideyama, Takuto
Watanabe, Eri
Ido, Nobuhiro
Terashi, Hiroo
Aizawa, Hitoshi
Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation
title Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation
title_full Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation
title_fullStr Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation
title_full_unstemmed Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation
title_short Non-traumatic Rectus Sheath Hematoma During Direct Oral Anticoagulation
title_sort non-traumatic rectus sheath hematoma during direct oral anticoagulation
topic Family/General Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598347/
https://www.ncbi.nlm.nih.gov/pubmed/37885548
http://dx.doi.org/10.7759/cureus.45876
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