Results 1 to 4 of 4

Thread: Lovenox and retroperitoneal bleed

  1. #1
    Managing Editor Jan B. Wade's Avatar
    Join Date
    Apr 1996
    Bellingham, Washington, United States

    Lovenox and retroperitoneal bleed

    In response to a question about Lovenox (enoxaparin) and retroperitoneal bleed

    Here's the label information
    Here's a comment from nanuke (scan down to nanuke) in a noblood forum

    I did some searching on lovenox and retroperitoneal bleed.
    No Abstract Available
    CONCLUSIONS: There are very few published reports implicating enoxaparin as a factor in retroperitoneal hematoma. It is hoped that the addition of these 2 cases to the medical literature creates more awareness that retroperitoneal hematoma should be considered in the differential diagnosis in patients receiving enoxaparin and experiencing unexplained decreases in hemoglobin and hematocrit.
    An 83-year-old woman was transferred to our cardiac intensive care unit with an acute non-Q-wave myocardial infarction and pulmonary edema. Enoxaparin was one component of the treatment regimen used. Her hospital course was complicated by episodes of hypotension, as well as by recurrent left hip and left thigh pain. The defining event occurred when the patient became acutely hypotensive and developed abdominal distention, peritoneal signs, intense left flank pain, and a 3.3 g/dl hemoglobin decrease. Abdominal computed tomography showed a 9 x 6 x 20 cm left retroperitoneal hematoma. The hematoma was spontaneous, secondary to enoxaparin use. The patient died despite vigorous supportive care. Enoxaparin is being increasingly used in patients with acute coronary syndromes. Review of the medical literature revealed that this is the first reported case of a patient with an acute coronary syndrome who died as a result of an enoxaparin-induced, spontaneous retroperitoneal hematoma. This article reviews important clinical signs and symptoms, identifies high-risk patient populations, and discusses management strategies.
    Enoxaparin (a low molecular weight heparin) has been used extensively for its antithrombotic properties. Complications of its haemorrhagic side-effects have previously been described. We report two cases of extensive retroperitoneal haematoma requiring blood transfusion and inotropic support. One patient developed acute renal failure and did not respond to intensive resuscitative efforts.
    A 58-year-old woman with chronic obstructive pulmonary disease had spontaneous bilateral hemothorax and a retroperitoneal hematoma after 4 days of anticoagulation therapy with enoxaparin (1 mg/kg subcutaneously every 12 hours) for suspected pulmonary thromboembolism. The patient was successfully managed with red blood cell and plasma transfusions, multiple thoracenteses for evacuation of blood from the pleural space, short-term mechanical ventilation, and administration of bronchodilators, corticosteroids, and antibiotics. This is the first report of spontaneous hemothorax and the third report of spontaneous retroperitoneal hematoma associated with enoxaparin therapy.
    OBJECTIVE: To describe a complication of low-molecular-weight heparin (enoxaparin) in the setting of critically ill patients. DESIGN: Case report. SETTING: The medical and surgical intensive care units of a tertiary care university teaching hospital. PATIENTS: Two adult patients receiving enoxaparin developed retroperitoneal hematoma and abdominal compartment syndrome. Both patients became anuric and required high-dose intravenous fluids and vasopressors to maintain blood pressure. INTERVENTION: Discontinuation of enoxaparin, followed by exploratory laparotomy and evacuation of the hematoma. MEASUREMENTS AND RESULTS: Immediate clinical improvement following evacuation of hematoma. CONCLUSIONS: High-risk patients receiving low-molecular-weight heparin should be identified and closely monitored to prevent serious bleeding complications.

    Mr. Jan B. Wade

    Click here for the Best Questions and Answers regarding Transfusion Alternatives and Patient Blood Management.

  2. New Feature! NoBlood Answers!

    • ASK questions regarding Transfusion Alternatives and Patient Blood Management.
    • SHARE your facts, opinions and personal experience.
    • DISCOVER the best answers chosen by Healthcare Professionals and the Public.
    • RANK the best answers.

    Click here to see the Best Answers to Top Questions.

  3. #2
    Registered User
    Join Date
    Aug 2012
    My Dad is in Mon General hospital suffering right now with a retropertinal bleed whic I believe is fully induced by the cocktail of blood thinners the thoracic surgeons had him on post op. which includes Lovenex. Praying he makes it. VERY SERIOUS.

  4. #3
    Physicians Hatice Simsek MD's Avatar
    Join Date
    Oct 2008
    Posted: 06/15/2010; Am J Health Syst Pharm. 2010;67(10):806-809. © 2010 American Society of Health-System Pharmacists
    From American Journal of Health-System Pharmacy
    Fatal Retroperitoneal Hematoma after Enoxaparin Administration in a Patient with Paroxysmal Atrial Flutter

    Retroperitoneal hematoma is a complication often encountered in the trauma patient and not commonly associated with enoxaparin use.[15] Other etiologies include tumors, vascular lesions, and surgical complications. Signs and symptoms of retroperitoneal hematoma vary widely based on etiology. They can include pain in the anterior abdomen, flank, back, or pelvic area; neurologic deficiencies; hematuria; and vomiting. Signs of hypovolemic shock are usually present in patients with significant hematomas. Because a Grey Turner sign is not usually present the first day after hematoma formation, it is usually not helpful in the early diagnosis of a retroperitoneal hematoma. Laboratory findings, such as anemia, may also be present. Abdominal and pelvic computed tomography remain the gold standard for identifying retroperitoneal hematomas...
    Two significant risk factors for bleeding complications have been discussed in the literature—renal insufficiency and age of ≥65 years.[1] ...
    Currently, there are no clinical guidelines outlining which patients have an increased risk of retroperitoneal bleeding associated with enoxaparin use. Clinicians must use caution when prescribing enoxaparin, especially in the elderly and in individuals with decreased CLcr. ...
    Medscape: Medscape Access

  5. #4
    Registered User
    Join Date
    Feb 2011
    The use of anticoagulants can sometimes be a two-edged sword. While essential for DVT prophlyaxis in the post operative patient they are not without risk. The risk is further heightened in a patient for whom blood transfusions are not an option since uncontrolled hemorrhage is not easily managed without transfusions.

    That being said, I feel that most physicians and patients do not fully appreciate the seriousness of ongoing anticoagulant management in a patient over the long term. Particularly alarming are the newer agents widely marketed as being superior because they do not require serial blood test monitoring. What is not articulated is that they do not require testing because their is no way to test for therapeutic response. Furthermore there is no reversal agent. There has been serious and fatal uncontrolled hemorrhage in patients on these newer agents. Attempts to rescue these patients with massive transfusions often fail.

    For persons who decline blood transfusions it is especially important to know what anticoagulant agents your doctor prescribes and the actual risks before you begin taking them. I

Similar Threads

  1. ESC: Lovenox Reduces Bleeding in Elective Angioplasty
    By Jan B. Wade in forum Medical Articles and Abstracts
    Replies: 0
    Last Post: 09-08-2005, 06:26 AM
  2. GI Bleed Protocol
    By bhubbs in forum Ask a Professional
    Replies: 1
    Last Post: 08-26-2004, 12:56 PM
  3. Lovenox and Acute Renal Failure
    By Melisa in forum Shop Talk
    Replies: 1
    Last Post: 12-29-2003, 10:33 AM
  4. Lovenox in the Emergency Department
    By Jan B. Wade in forum Ask a Professional
    Replies: 7
    Last Post: 05-13-2003, 02:43 PM

Tags for this Thread


Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts