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

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 anticoa...

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Autores principales: Liu, Shangxiang, Mei, Chengqing, Zou, Hui, Chang, Xiaoliang, Ye, Zhenglong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294477/
https://www.ncbi.nlm.nih.gov/pubmed/32587696
http://dx.doi.org/10.1177/2050313X20931680
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author Liu, Shangxiang
Mei, Chengqing
Zou, Hui
Chang, Xiaoliang
Ye, Zhenglong
author_facet Liu, Shangxiang
Mei, Chengqing
Zou, Hui
Chang, Xiaoliang
Ye, Zhenglong
author_sort Liu, Shangxiang
collection PubMed
description 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 × 10(9)/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.
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spelling pubmed-72944772020-06-24 Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report Liu, Shangxiang Mei, Chengqing Zou, Hui Chang, Xiaoliang Ye, Zhenglong SAGE Open Med Case Rep Case Report 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 × 10(9)/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. SAGE Publications 2020-06-13 /pmc/articles/PMC7294477/ /pubmed/32587696 http://dx.doi.org/10.1177/2050313X20931680 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Liu, Shangxiang
Mei, Chengqing
Zou, Hui
Chang, Xiaoliang
Ye, Zhenglong
Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report
title Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report
title_full Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report
title_fullStr Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report
title_full_unstemmed Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report
title_short Iliopsoas hematoma associated with low-molecular-weight heparin use: A case report
title_sort iliopsoas hematoma associated with low-molecular-weight heparin use: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294477/
https://www.ncbi.nlm.nih.gov/pubmed/32587696
http://dx.doi.org/10.1177/2050313X20931680
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