Malik Ahmed, Capling Richard, Bastani Bahar
Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, MO 63110, USA.
Pharmacotherapy. 2005 May;25(5):769-72. doi: 10.1592/phco.25.5.769.63596.
Two patients with chronic kidney disease experienced a major bleeding event, retroperitoneal hematoma, requiring a blood transfusion after the administration of enoxaparin. The first patient was a 61-year-old Caucasian woman with multiple comorbidities, including chronic kidney disease stage 4. She received subcutaneous enoxaparin 45 mg every 12 hours, along with antiplatelet agents. On the seventh day, she developed a large retroperitoneal hematoma and her hematocrit had decreased, requiring a transfusion of packed red blood cells. The second patient was a 74-year-old, obese Caucasian woman with multiple comorbidities, including chronic kidney disease stage 2-3 and atrial fibrillation. She was given enoxaparin 120 mg every 12 hours, along with warfarin and aspirin to prevent embolization. She developed a large retroperitoneal hematoma and died despite vigorous supportive care. Enoxaparin should be administered with great caution in patients with chronic kidney disease, especially if antiplatelet agents or other anticoagulants are administered concomitantly.
两名慢性肾病患者在使用依诺肝素后发生了严重出血事件，即腹膜后血肿，需要输血。第一名患者是一名61岁的白种女性，有多种合并症，包括4期慢性肾病。她每12小时皮下注射45毫克依诺肝素，同时服用抗血小板药物。在第7天，她出现了一个大的腹膜后血肿，血细胞比容下降，需要输注浓缩红细胞。第二名患者是一名74岁的肥胖白种女性，有多种合并症，包括2-3期慢性肾病和房颤。她每12小时接受120毫克依诺肝素治疗，同时服用华法林和阿司匹林以预防栓塞。她出现了一个大的腹膜后血肿，尽管给予了积极的支持治疗仍死亡。对于慢性肾病患者，尤其是同时使用抗血小板药物或其他抗凝剂的患者，应极其谨慎地使用依诺肝素。
