title: Recombinant activated factor VII treatment of retroperitoneal hematoma in a patient with renal failure receiving enoxaparin and clopidogrel.
abstract: Enoxaparin is a low-molecular-weight heparin that has pharmacokinetic and therapeutic advantages over unfractionated heparin in certain clinical conditions. However, its administration is not without risk. We describe the case of a 70-year-old woman with numerous medical problems who developed severe retroperitoneal bleeding after receiving several therapeutic doses of subcutaneous enoxaparin that inadvertently were not adjusted for her renal function until day 14 of therapy. She had severe bleeding with hemodynamic instability and required massive transfusions of blood products. Her bleeding could be controlled only by administration of four doses of recombinant activated factor VII (factor VIIa) in addition to embolization of the bleeding sites through angiographic microcoiling. The patient's hemodynamic status improved, and her hemoglobin level stabilized. This case report provides evidence of the clinical effectiveness of factor VIIa use as part of the management of refractory enoxaparin-induced retroperitoneal bleeding. However, further studies are needed to validate the dose-response relationship and further support the clinical utility of factor VIIa in this life-threatening situation.
authors.affiliation: Intensive Care Department, King Abdulaziz Medical City-NGHA, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Antoine
authors.initials: A
authors.lastname: Cherfan
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Askar
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Shimemeri
mesh_terms: D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016913:Blood Component Transfusion; D000077144:Clopidogrel; D004347:Drug Interactions; D004621:Embolization, Therapeutic; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects*; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D006406:Hematoma / Q000139:chemically induced*; D006454:Hemoglobins; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011994:Recombinant Proteins / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000150:complications*; D012187:Retroperitoneal Space / Q000473:pathology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D005167:Factor VII; D000077144:Clopidogrel; C103587:recombinant FVIIa; D015942:Factor VIIa; D013988:Ticlopidine