Spontaneous iliopsoas hematoma in patients with unstable coronary syndromes receiving intravenous heparin in therapeutic doses.
OBJECTIVE
To identify the relationship between the use of anticoagulants, specifically heparin, and the development of iliacus and psoas muscle hematoma. Three patients with unstable angina who developed groin pain while on heparin anticoagulation are presented. Patients who are anticoagulated with heparin are at increased risk of developing iliacus or psoas hematoma, manifesting a wide range of symptoms from groin pain to massive bleeding and shock. Identification of these patients is crucial in cardiology practice.


METHODS
MEDLINE searches under "iliacus', "psoas' and "iliopsoas hematoma' were conducted and cross-referenced with patients on anticoagulant therapy. Only English language articles were included.


METHODS
The search covered January 1966 to February 1995. Fifty-one articles were studied.


RESULTS
The current literature suggests that anticoagulation can cause iliacus or psoas muscle hematoma and usually presents as femoral neuropathy. However, the presented case reports provide evidence that an earlier manifestation of this entity is the development of groin pain, and that early identification is crucial to improving patient morbidity and mortality.


CONCLUSIONS
Patients who are on heparin anticoagulation should be carefully monitored for development of groin pain or leg weakness. In such cases, early recognition of possible iliacus or psoas hematoma should be by abdominal ultrasound or computed tomography, and heparin anticoagulation should be modified according to its clinical requirement.
Sasson
Z
Z
Department of Medicine, Wellesley Hospital, University of Toronto, Ontario.
Mangat
I
I
Peckham
K A
KA
D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000188:drug therapy; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D005260:Female; D006406:Hematoma / Q000188:drug therapy / Q000209:etiology*; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007275:Injections, Intravenous; D011183:Postoperative Complications; D016658:Psoas Muscles / Q000098:blood supply*; D016896:Treatment Outcome
D006493:Heparin