Triscott Jean, Mercer Susan, Tian Peter George Jaminal, Dobbs Bonnie
Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Family Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada.
BMJ Case Rep. 2015 Oct 5;2015:bcr2015211699. doi: 10.1136/bcr-2015-211699.
An 81-year-old woman with chronic kidney disease was on enoxaparin (1 mg/kg subcutaneously two times a day) for 4 months to manage pulmonary embolism. While admitted for diagnostic evaluation of frequent falls, transient ischaemic attacks and pain management, she developed vomiting, diarrhoea, melena and hypotension. Her estimated glomerular filtration rate decreased from an admission value of 34 mL/min/1.73 m2 to 13 mL/min/1.73 m2. CT scan showed retroperitoneal haematoma. She was placed in intensive care and stabilised with aggressive fluid replacement, blood transfusion, and discontinuation of enoxaparin and concomitant aspirin. We attribute this major bleeding to enoxaparin use in an elderly woman with chronic kidney disease and concomitant aspirin intake. We will review reported cases of enoxaparin-associated retroperitoneal haematoma. We suggest that enoxaparin be used with caution in elderly patients with chronic kidney disease, and stress that treatment monitoring and reversal may not be readily available.
一名患有慢性肾脏病的81岁女性接受依诺肝素治疗（1毫克/千克，皮下注射，每日两次），持续4个月以治疗肺栓塞。在因频繁跌倒、短暂性脑缺血发作及疼痛管理而入院进行诊断评估期间，她出现了呕吐、腹泻、黑便及低血压症状。她的估算肾小球滤过率从入院时的34毫升/分钟/1.73平方米降至13毫升/分钟/1.73平方米。CT扫描显示腹膜后血肿。她被收入重症监护病房，并通过积极补液、输血以及停用依诺肝素和同时服用的阿司匹林而病情稳定。我们将此次严重出血归因于在一名患有慢性肾脏病且同时服用阿司匹林的老年女性中使用依诺肝素。我们将回顾已报道的依诺肝素相关腹膜后血肿病例。我们建议在患有慢性肾脏病的老年患者中谨慎使用依诺肝素，并强调可能无法随时进行治疗监测及逆转。
