title: [Hemorrhage after Implanon replacement when using oral anticoagulants].
abstract: BACKGROUND
  Implanon is a widely used contraceptive. It is a progestagen-containing implant which is inserted subcutaneously on the inside of the upper arm. This procedure is relatively simple.
  
  
  METHODS
  A 26-year-old woman had her contraceptive implant replaced in the outpatient clinic. Because of a mechanical heart valve, she used phenprocoumon, which she did not discontinue prior to the procedure. Three days after the Implanon replacement, the patient presented with persistent blood loss from the insertion site and a large hematoma around the new implant. The placement of a new pressure bandage was not sufficient. The concentration of Hb fell from 8.1 to 5.0 mmol/l with an INR of 3.5; therefore, the patient received a blood transfusion. The use of phenprocoumon was temporarily discontinued and the INR was corrected with prothrombin complex. Good hemostasis was ultimately achieved.
  
  
  CONCLUSIONS
  Although the replacement of a subcutaneous hormone implant is a relatively simple procedure, a severe complication such as hemorrhaging may occur, particularly when there are risk factors.
authors.affiliation: UMC St Radboud, afd. Gynaecologie en Verloskunde, Nijmegen.
authors.forename: J C Bianca
authors.initials: JC
authors.lastname: van Ginderen
authors.forename: Janneke S
authors.initials: JS
authors.lastname: Hoogstad-van Evert
authors.forename: Joris
authors.initials: J
authors.lastname: van Drongelen
authors.forename: Theodoor E
authors.initials: TE
authors.lastname: Nieboer
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D001803:Blood Transfusion; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D017135:Desogestrel / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D019934:International Normalized Ratio; D010644:Phenprocoumon / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D003271:Contraceptive Agents, Female; C044815:etonogestrel; D017135:Desogestrel; D010644:Phenprocoumon