Enoxaparin associated with huge abdominal wall hematomas: A report of two cases

Enoxaparin is a low-molecular-weight heparin used for prophylaxis against d eep venous thrombosis. Indications include hip and knee replacement surgery , risk of deep venous thrombosis during abdominal surgery, and prevention o f ischemic complications of unstable angina and non-Q-wave myocardial infar ction. Its efficacy in the prevention of the above complications has been p reviously studied; however, the liberal use of enoxaparin is not without in cident. Complications of enoxaparin include hemorrhage, thrombocytopenia, a nd local reactions. Since 1993 there have been more than 40 reports of epid ural or spinal hematoma formation with the concurrent use of enoxaparin and spinal/epidural anesthesia or spinal puncture. Herein reported are two cas es of abdominal wall hematomas in patients receiving prophylaxis with enoxa parin. Both patients sustained an unexplained fall in the hematocrit and ab dominal pain. A CT scan confirmed the diagnosis. One patient recovered unev entfully; however, the other patient, on chronic hemodialysis, became hemod ynamically unstable and hyperkalemic and sustained a fatal cardiac arrhythm ia. An extensive review of the literature revealed no similar eases of abdo minal wall hematomas associated with enoxaparin although other complication s, including spinal and epidural hematomas, psoas hematomas, and skin necro sis have been reported. The extended use of enoxaparin as an anticoagulant requires the physician to be vigilant of these rare complications. Bleeding can occur at any site during therapy with enoxaparin. An unexplained fall in the hematocrit or blood pressure should lead to a search for a bleeding site.