ABSTRACT
Rectus sheath hematoma is a rare complication of anticoagulant therapy. We have described the case of a 78-year-old woman with unstable angina who developed a life-threatening rectus sheath hematoma during treatment with antiplatelet drugs and enoxaparin. The patient had underlying diseases of hypertension and triple vessels disease status post coronary artery bypass graft. She was admitted initially with an asthmatic attack. Three days later, she developed unstable angina and thus received aspirin, clopidogrel, and enoxaparin. After the fifth dose of enoxaparin, she developed progressive suprapubic pain with a newly palpable mass, anemia, hypotension, and oliguria. Abdominal computed tomography revealed a rectus sheath hematoma sized 15 cm., (about 2,000 mL by volume). Her coagulogram was normal. Despite rapid fluid resuscitation, packed red cell transfusion (1,300 mL), platelet transfusion, and protamine sulfate injection, the patient’s hemodynamic status remained unstable. Finally recombinant activated factor VII (rFVIIa) injection improved her hemodynamic status and stabilized her hemoglobin level without a thrombotic complication. This case report provides evidence of the benefit of rFVIIa use as a part of the treatment of refractory bleeding from enoxaparin.
ABSTRACT
A national survey of patients with hemophilia and other congenital bleeding disorders in Thailand was conducted in the years 2000 to 2002. Questionnaires were sent to physicians working at hospitals throughout the country. Although the overall response rate to the questionnaires was 19%, the two highest rates of 80% and 73.7% were found at university and regional hospitals, respectively, where most of the patients received their diagnosis and treatment. A total of 1,450 patients comprised of hemophilia 1,325 cases, von Willebrand disease, 69 cases, congenital factor VII deficiency, 15 cases, hereditary platelet dysfunction, 22 cases, and undefined causes of congenital bleeding disorders, 19 cases. Most were pediatric patients <15 years of age. Treatment was mainly given on demand for a bleeding episode, while only 8.6% received additional home treatment for early bleeding episodes. Replacement therapy primarily relied on fresh frozen plasma, cryoprecipitate and cryo-removed plasma. Factor concentrate was seldom used because of the high price. As a result, hemophilia care services in Thailand should be strengthened by providing comprehensive education for medical personnel, making available simple laboratory kits to determine hemophilia A and B, ensuring an adequate supply of blood components and affordable factor concentrate, and establishing home care treatment.