Enoxaparin-induced bleeding resulting in compartment syndrome of the thigh: a case report.
BACKGROUND
Enoxaparin-related bleeding has usually been described as excess minor bleeding.


OBJECTIVE
To describe a case of major bleeding with a compartment syndrome secondary to enoxaparin. The utility of bedside emergency department ultrasonography as a diagnostic tool is evident.


METHODS
A 62-year-old patient presented with swelling and pain in the left thigh with no history of trauma. Examination revealed a swollen extremity with a tense muscle compartment. A bedside ultrasound by the emergency physician was performed, showing a large pocket of fluid accumulation. Upon aspiration, the fluid was found to be blood. Computed tomography imaging was performed, which revealed a large hematoma, with active bleeding. Subsequent angiography showed several extravasations from the profunda artery. The patient was then taken for embolization of the bleeding, and then an anterolateral fasciotomy. The patient had an increased partial thromboplastin time, and final diagnosis was compartment syndrome due to spontaneous bleeding from enoxaparin.


CONCLUSIONS
Enoxaparin can spontaneously cause serious bleeding with associated compartment syndrome.
Limberg
Ryan M
RM
Department of Emergency Medicine, Los Angeles County + USC Medical Center, Los Angeles, California, USA.
Dougherty
Colin
C
Mallon
William K
WK
D000925:Anticoagulants / Q000009:adverse effects*; D003161:Compartment Syndromes / Q000139:chemically induced* / Q000000981:diagnostic imaging; D017984:Enoxaparin / Q000009:adverse effects*; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D013848:Thigh; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000925:Anticoagulants; D017984:Enoxaparin