Limberg Ryan M, Dougherty Colin, Mallon William K
Department of Emergency Medicine, Los Angeles County + USC Medical Center, Los Angeles, California, USA.
J Emerg Med. 2011 Jul;41(1):e1-4. doi: 10.1016/j.jemermed.2008.04.016. Epub 2008 Nov 7.
Enoxaparin-related bleeding has usually been described as excess minor bleeding.
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.
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.
Enoxaparin can spontaneously cause serious bleeding with associated compartment syndrome.
依诺肝素相关出血通常被描述为过多的轻微出血。
描述一例因依诺肝素导致伴有骨筋膜室综合征的严重出血病例。床边急诊科超声作为一种诊断工具的实用性是显而易见的。
一名62岁患者，左大腿出现肿胀和疼痛，无外伤史。检查发现肢体肿胀，肌肉骨筋膜室紧张。急诊科医生进行了床边超声检查，显示有一大片液体积聚。抽吸后发现液体为血液。进行了计算机断层扫描成像，显示有一个大血肿，伴有活动性出血。随后的血管造影显示股深动脉有多处造影剂外渗。然后该患者接受了出血栓塞治疗，随后进行了前外侧筋膜切开术。该患者部分凝血活酶时间延长，最终诊断为依诺肝素自发性出血导致的骨筋膜室综合征。
依诺肝素可自发引起严重出血并伴有相关的骨筋膜室综合征。
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