title: Bleeding the system: a case of feigned enoxaparin overdose.
abstract: BACKGROUND
  Low-molecular-weight heparins (LMWHs) have become ubiquitously used as anticoagulants because of their comparative safety and ease of use; however they may be fatal if taken in overdose, and lack of familiarity with their pharmacology may hinder appropriate care.
  
  
  OBJECTIVE
  The author reports a case of feigned LMWH overdose so as to alert practitioners to this diagnostic possibility.
  
  
  METHODS
  This is a case report of a 49-year-old homeless man who reported a deliberate overdose of an injectable LMWH. The author reviews the mechanism of action and monitoring of LMWHs.
  
  
  RESULTS
  On the basis of his unusual presentation and previously documented history and medical work-up, he was ultimately diagnosed with malingering.
  
  
  CONCLUSIONS
  Feigned LMWH overdose is ideally suited to the purposes of malingering, since it represents a medical emergency that requires inpatient medical hospitalization and testing at outside laboratory facilities to verify the overdose.
authors.affiliation: St. Joseph's Hospital and Medical Center, 222 W. Thomas Rd., Suite 110A, Phoenix, AZ 85013, USA. jason.caplan@chw.edu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Caplan
mesh_terms: D000925:Anticoagulants / Q000506:poisoning*; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000175:diagnosis* / Q000523:psychology; D017984:Enoxaparin / Q000506:poisoning*; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008306:Malingering / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin