ABSTRACT
BACKGROUND: Enoxaparin-related bleeding has usually been described as excess minor bleeding. OBJECTIVES: To describe a case of major bleeding with a compartment syndrome secondary to enoxaparin. The utility of bedside emergency department ultrasonography as a diagnostic tool is evident. CASE REPORT: A 62-year-old patient presented with swelling and pain in the left thigh with no history of trauma. Examination revealed a swollen extremity with a tense muscle compartment. A bedside ultrasound by the emergency physician was performed, showing a large pocket of fluid accumulation. Upon aspiration, the fluid was found to be blood. Computed tomography imaging was performed, which revealed a large hematoma, with active bleeding. Subsequent angiography showed several extravasations from the profunda artery. The patient was then taken for embolization of the bleeding, and then an anterolateral fasciotomy. The patient had an increased partial thromboplastin time, and final diagnosis was compartment syndrome due to spontaneous bleeding from enoxaparin. CONCLUSIONS: Enoxaparin can spontaneously cause serious bleeding with associated compartment syndrome.