ABSTRACT
Mechanical heart valves (MHVs) are thrombogenic and require lifelong anticoagulation with vitamin K antagonists (VKAs) such as warfarin. Periprocedural bridging with unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) aims to reduce the risk of thromboembolic events in patients. Currently, there are no definitive class I recommendations for anticoagulation management in patients with MHVs. In this report, we present the case of a 77-year-old female who was perioperatively bridged with enoxaparin and subsequently developed an acute thrombus.
ABSTRACT
We present two variant cases of spontaneous rectus sheath hematoma (SRSH). A 71-year-old woman presented with ST elevation myocardial infarction and was found to have multivessel coronary artery disease. She was treated with aspirin, clopidogrel, eptifibatide, and heparin. Heparin was continued while preoperative workup for coronary artery bypass grafting was done. She developed a large 20x10 cm actively bleeding SRSH while on heparin. It was surgically evacuated. The second case represents an atypical cause of SRSH. A 64-year-old woman with Wegener's Granulomatosis presented with anemia and abdominal pain. Abdominal CT showed a large 22 cm SRSH without active bleeding that was treated conservatively. Both patients did well on follow-up. The incidence of SRSH is likely to increase in the coming years with the increasing use of antithrombotic agents for many disease processes. Clinicians should be aware of typical and atypical presentations of SRSH and its variant management options.
Subject(s)
Abdominal Pain , Anemia , Anticoagulants/adverse effects , Coronary Artery Disease , Granulomatosis with Polyangiitis , Hematoma , ST Elevation Myocardial Infarction , Tomography, X-Ray Computed , Abdominal Pain/chemically induced , Abdominal Pain/diagnostic imaging , Abdominal Pain/therapy , Aged , Anemia/diagnostic imaging , Anemia/therapy , Anticoagulants/administration & dosage , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Female , Granulomatosis with Polyangiitis/diagnostic imaging , Granulomatosis with Polyangiitis/therapy , Hematoma/chemically induced , Hematoma/diagnostic imaging , Hematoma/therapy , Humans , Middle Aged , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapyABSTRACT
Hetrotaxy syndrome is defined as an abnormality where the internal thoraco-abdominal organs demonstrate abnormal arrangement across the left-right axis of the body. Although it is a known condition among physicians taking care of pediatric patients, it is rarely seen in adult day-to-day medicine and most physicians involved in care of adult patients are unaware of it. It is important to recognize this anomaly based on clinical findings,due to its reported association with various medical conditions. We report a case of a 77-year-old patient diagnosed with Hetrotaxy syndrome.
