Wallach H W, Oren M E
Arch Neurol. 1979 Jul;36(7):448. doi: 10.1001/archneur.1979.00500430078016.
Severe hip pain developed in a patient who was receiving anticoagulation therapy of heparin sodium and warfarin sodium (Coumadin) for femoral vein phlebitis. The patient had exquisite tenderness but no ecchymoses along the sciatic nerve. A drop in the hemoglobin level showed a large volume loss of blood. Retroperitoneal hematoma with lumbar plexopathy was suspected, but a computerized tomographic scan revealed instead hemorrhage into the gluteal muscles. The anticoagulation therapy was corrected with the addition of protamine sulfate and vitamin K; the patient's pain lessened and the hemoglobin level stabilized. Computerized tomography allowed clear visualization of the hematomas in the buttock, and invasive studies were avoided. Hip pain and a falling hemoglobin level in a patient receiving anticoagulation therapy should alert one to the possibility of bleeding into the retroperitoneal space, thigh, or buttock.
一名因股静脉炎接受肝素钠和华法林钠（香豆素）抗凝治疗的患者出现了严重的髋部疼痛。患者有明显压痛，但坐骨神经沿线无瘀斑。血红蛋白水平下降表明有大量失血。怀疑有伴有腰丛病变的腹膜后血肿，但计算机断层扫描显示是臀肌内出血。通过加用硫酸鱼精蛋白和维生素K纠正了抗凝治疗；患者的疼痛减轻，血红蛋白水平稳定。计算机断层扫描能够清晰显示臀部的血肿，从而避免了侵入性检查。接受抗凝治疗的患者出现髋部疼痛和血红蛋白水平下降应提醒警惕腹膜后间隙、大腿或臀部出血的可能性。
