Choi Beatrix Hyemin, Koeckert Michael, Tomita Sandra
Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA.
Department of Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA.
Case Rep Pediatr. 2018 Jun 13;2018:8780121. doi: 10.1155/2018/8780121. eCollection 2018.
There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy. We present the case of a 4-year-old boy who was placed on LMWH for a catheter-related deep venous thrombosis in the setting of intractable seizures and subsequently developed a small bowel obstruction secondary to a suspected intussusception. He underwent exploratory laparotomy and was found to have an intramural bowel hematoma. Prior to this bleed, the patient had been monitored daily, and his anti-Xa levels were found to be in the therapeutic range. This case highlights the need for a high index of suspicion for spontaneous bleeding even in the setting of therapeutic anti-Xa levels.
低分子量肝素（LMWH）在儿科血栓栓塞性疾病治疗中的应用日益增加，因为已证明其安全有效。与普通肝素相比，它有几个优点，如监测需求减少、给药途径更简便、肝素诱导的血小板减少症风险降低以及不存在药物相互作用。然而，与任何抗凝治疗一样，LMWH仍然存在出血风险。我们报告一例4岁男孩的病例，该男孩因顽固性癫痫发作并发导管相关深静脉血栓形成而接受LMWH治疗，随后因疑似肠套叠继发小肠梗阻。他接受了剖腹探查术，发现有肠壁内血肿。在此次出血之前，患者每天都接受监测，其抗Xa水平在治疗范围内。该病例强调，即使在抗Xa水平处于治疗范围的情况下，也需要高度怀疑自发性出血。
