Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine Permian Basin, Odessa, Texas, USA
Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine Permian Basin, Odessa, Texas, USA.
BMJ Case Rep. 2024 Mar 15;17(3):e259539. doi: 10.1136/bcr-2023-259539.
Spontaneous gastric intramural haematoma is an uncommon complication associated with anticoagulant therapy. A patient receiving chronic warfarin for paroxysmal atrial fibrillation was admitted due to atrial fibrillation with rapid ventricular response (RVR). An incidental intra-abdominal mass was detected on a CT scan. Following the initiation of the amiodarone infusion, the patient experienced bleeding attributed to warfarin-amiodarone-induced coagulopathy, with no identifiable bleeding source. Subsequent CT scans revealed an enlargement of the intra-abdominal mass, suggesting gastric intramural haematoma. After coagulopathy reversal, the haematoma is managed conservatively. Our case underscores the potential for incidental bleeding even when the international normalised ratio is within the normal range in patients on chronic warfarin therapy. When managing such patients with atrial fibrillation with RVR, physicians should maintain a high index of suspicion for bleeding, emphasising the importance of prompt coagulopathy reversal.
自发性胃壁内血肿是一种罕见的与抗凝治疗相关的并发症。一名因阵发性心房颤动接受慢性华法林治疗的患者因快速心室反应（RVR）而入院。腹部 CT 扫描发现偶然的腹腔内肿块。胺碘酮输注开始后，患者出现出血归因于华法林-胺碘酮诱导的凝血障碍，无明显出血源。随后的 CT 扫描显示腹腔内肿块增大，提示胃壁内血肿。凝血障碍纠正后，血肿保守治疗。我们的病例强调了即使在慢性华法林治疗患者的国际标准化比值在正常范围内，也可能发生意外出血。当处理伴有 RVR 的心房颤动患者时，医生应保持高度警惕出血，并强调及时纠正凝血障碍的重要性。
