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Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty

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Abstract

Low-molecular-weight heparins have become the predominant choice for deep venous thrombosis prophylaxis and treatment. However, their use may cause bleeding complications. Intrahepatic bleeding is exceptional and only very few cases have been described. The authors present a unique case of fatal intrahepatic hematoma complicating nadroparin use in a 65-year-old woman with a hepatic cyst who was admitted to hospital for unilateral total hip arthroplasty. At autopsy, hemoperitoneum (2,000 ml of blood and clots) was evident. A ruptured sub-capsular hematoma involving the right lobe of the liver was observed. The hemorrhage within the cyst induced by the nadroparin use was likely responsible for the subsequent hepatic hematoma, liver rupture, and death. This case highlights the need for pathologists and surgeons to be aware of the possibility of intrahepatic hematoma in patients who have received low-molecular-weight heparins, undergone major surgery and present postoperative hemodynamic instability, especially in those with preoperative diagnosis of hepatic cyst.

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References

  1. Daggett JR, Chung S, Smith PD. Bilateral spontaneous, simultaneous lower extremity hematomas in a patient on dalteparin. Int J Surg Case Rep. 2013;4:1080–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Argun M, Oner M, Saglamoglu M, Karaman I, Guney A, Halici M, Kafadar IH. Fondaparınux versus nadroparın for preventıon of venous thromboembolısm after electıve hıp and knee arthroplasty. Curr Ther Res Clin Exp. 2013;74:49–53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment. Chest. 2001;119(1 Suppl):108S–21S.

    Article  CAS  PubMed  Google Scholar 

  4. Schulman S, Beyth RJ, Kearon C, Levine MN; American College of Chest Physicians. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):257S–98S.

  5. Vayá A, Mira Y, Aznar J, Todolí J, Arguedas J, Solá E. Enoxaparin-related fatal spontaneous retroperitoneal hematoma in the elderly. Thromb Res. 2003;110:69–71.

    Article  PubMed  Google Scholar 

  6. Ernits M, Mohan PS, Fares LG II, Hardy H III. A retroperitoneal bleed induced by enoxaparin therapy. Am Surg. 2005;71:430–3.

    PubMed  Google Scholar 

  7. Houde JP, Steinberg G. Intrahepatic hemorrhage after use of low-molecular-weight heparin for total hip arthroplasty. J Arthroplast. 1999;14:372–4.

    Article  CAS  Google Scholar 

  8. White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med. 1998;158:1525–31.

    Article  CAS  PubMed  Google Scholar 

  9. Burg MD, Dallara JJ. Rupture of a previously normal spleen in association with enoxaparin: an unusual cause of shock. J Emerg Med. 2001;20:349–52.

    Article  CAS  PubMed  Google Scholar 

  10. Dabney A, Bastani B. Enoxaparin-associated severe retroperitoneal bleeding and abdominal compartment syndrome: a report of two cases. Intensive Care Med. 2001;27:1954–7.

    Article  CAS  PubMed  Google Scholar 

  11. Won DY, Kim SD, Park SC, Moon IS, Kim JI. Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation. Yonsei Med J. 2011;52:358–61.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Deprez FC, Colin GC, Hainaut P. Spontaneous (atraumatic) splenic rupture complicating anticoagulant treatment for splenic infarction. Acta Cardiol. 2013;68:421–4.

    PubMed  Google Scholar 

  13. Lissoway J, Booth A. Fatal retroperitoneal hematoma after enoxaparin administration in a patient with paroxysmal atrial flutter. Am J Health Syst Pharm. 2010;67:806–9.

    Article  CAS  PubMed  Google Scholar 

  14. Chan-Tack KM. Fatal spontaneous retroperitoneal hematoma secondary to enoxaparin. South Med J. 2003;96:58–60.

    Article  PubMed  Google Scholar 

  15. Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med. 2012;43:e157–61.

    Article  PubMed  Google Scholar 

  16. Iriz E, Ereren E, Yuksel O, Kalaycioglu S. Free intra-abdominal hemorrhage after open-heart surgery: an unusual gastrointestinal complication. Tex Heart Inst J. 2006;33:523–5.

    PubMed Central  PubMed  Google Scholar 

  17. Karl T. Spontaneous hematoma of the liver associated with heparin therapy. Conn Med. 1983;47:323–5.

    CAS  PubMed  Google Scholar 

  18. Roberts MH, Johnston FR. Hepatic rupture from anticoagulant therapy. Arch Surg. 1975;110:1152.

    Article  CAS  PubMed  Google Scholar 

  19. Dizadji H, Hammer R, Strzyz B, Weisenberger J. Spontaneous rupture of the liver. A complication of oral anticoagulant therapy. Arch Surg. 1979;114:734–5.

    Article  CAS  PubMed  Google Scholar 

  20. Mir NH, Shah MT, Obeid MA, Gallo R, Aliter H. Spontaneous bleeding from liver after open heart surgery. Int J Surg Case Rep. 2013;4:803–4.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Yu JH, Du Y, Li Y, Yang HF, Xu XX, Zheng HJ, Li B. Effectiveness of CT-guided sclerotherapy with estimated ethanol concentration for treatment of symptomatic simple hepatic cysts. Clin Res Hepatol Gastroenterol. 2014;38:190–4.

    Article  CAS  PubMed  Google Scholar 

  22. Macedo FI. Current management of noninfectious hepatic cystic lesions: a review of the literature. World J Hepatol. 2013;5:462–9.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Pinto DC, Haden-Pinneri K, Love JC. Manual and automated cardiopulmonary resuscitation (CPR): a comparison of associated injury patterns. J Forensic Sci. 2013;58:904–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Legal Medicine, University of Genova, Genova, Italy

    Francesco Ventura, Alessandro Bonsignore, Francesco De Stefano & Enrico Pizzorno

  2. University Center of Legal Medicine (Centre Universitaire Romand de Médecine Légale), Rue du Bugnon 21, 1011, Lausanne, Switzerland

    Cristian Palmiere

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  1. Francesco Ventura
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  2. Alessandro Bonsignore
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  3. Francesco De Stefano
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  4. Enrico Pizzorno
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  5. Cristian Palmiere
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Correspondence to Cristian Palmiere.

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Ventura, F., Bonsignore, A., De Stefano, F. et al. Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty. Forensic Sci Med Pathol 10, 619–622 (2014). https://doi.org/10.1007/s12024-014-9593-0

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  • DOI: https://doi.org/10.1007/s12024-014-9593-0

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