title: Dalteparin-associated catastrophic retroperitoneal hematoma successfully treated with recombinant factor VIIa.
abstract: Low-molecular-weight heparins (LMWHs) have been widely used in many clinical settings. LMWH-associated spontaneous retroperitoneal hematoma (SRH) has been reported mostly in patients treated with enoxaparin. We here present a 76-year-old man with renal insufficiency treated with dalteparin for acute myocardial infarction, who developed catastrophic SRH with intra-abdominal hypertension (IAH) and hemothorax. Because of the high risk of surgical intervention, we performed ultrasound-guided abdominal paracentesis and thoracentesis to relieve IAH and respiratory distress. Vigorous supportive care with massive blood product transfusions was given to stabilize his hemodynamics. Finally, the bleeding was stopped with a powerful hemostatic agent, recombinant factor VIIa. Surgical evacuation of a 3,600 mL blood clot was performed successfully 1 month later.
authors.affiliation: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
authors.forename: Ching-Hsun
authors.initials: CH
authors.lastname: Wang
authors.forename: Yeu-Chin
authors.initials: YC
authors.lastname: Chen
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tsao
authors.forename: Sung-Sen
authors.initials: SS
authors.lastname: Yang
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D017985:Dalteparin / Q000009:adverse effects* / Q000627:therapeutic use; D015942:Factor VIIa / Q000627:therapeutic use*; D006406:Hematoma / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D012187:Retroperitoneal Space
chemical_list: D000925:Anticoagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa; D017985:Dalteparin