Türk Elisabeth E, Verhoff Marcel A, Tsokos Michael
Institute of Legal Medicine, University of Hamburg, Germany.
Am J Forensic Med Pathol. 2002 Dec;23(4):342-4. doi: 10.1097/00000433-200212000-00008.
Two cases of massive iliopsoas muscle bleeding leading to fatal exsanguination are presented. Both patients (two women, 61 and 74 years old, respectively) received oral anticoagulation with phenprocoumon. The intramuscular bleeding occurred spontaneously in women of relatively good physical condition. Intriguingly, phenprocoumon concentrations were within the therapeutic range (1.55 microg/ml and 1.26 microg/ml, respectively) as detected by toxicologic analysis. These cases demonstrate that severe bleeding in the iliopsoas muscle has to be considered in all patients receiving anticoagulant medication, even in those who have coagulation parameters within the therapeutic range. Especially in older patients with a high degree of comorbidity or in patients receiving analgesic drugs, the potential of fatal outcome of iliopsoas muscle bleeding seems to be of clinicopathologic relevance.
本文报告了两例因巨大髂腰肌出血导致致命性失血的病例。两名患者（均为女性，分别为61岁和74岁）均接受苯丙香豆素口服抗凝治疗。肌肉内出血在身体状况相对良好的女性中自发发生。有趣的是，经毒理学分析检测，苯丙香豆素浓度分别在治疗范围内（分别为1.55微克/毫升和1.26微克/毫升）。这些病例表明，所有接受抗凝药物治疗的患者，即使其凝血参数在治疗范围内，也必须考虑髂腰肌严重出血的可能性。特别是在合并症程度较高的老年患者或接受镇痛药治疗的患者中，髂腰肌出血导致致命后果的可能性似乎具有临床病理意义。
