title: Life-threatening haemorrhage in patients without pulmonary embolism who received anticoagulants.
abstract: Local and international guidelines recommend that anticoagulation should be initiated before diagnostic work up has been completed, in patients with high clinical probability of pulmonary embolism (PE). However, many patients receiving anticoagulants for suspected PE do not have this disease. We present three cases of life-threatening bleeding complications after treatment with low-molecular-weight heparins for suspected PE. A 35-year-old woman had acute chest pain and died of a ruptured thoracic aneurysm. A man with herpes encephalitis developed acute dyspnoea, and died of intracerebral haemorrhage. And a woman with mild chest trauma had a complicated recovery after life-threatening intrapleural haemorrhage. Neither of these patients had PE. These cases emphasise that delaying diagnostics may pose a risk in patients with acute chest symptoms. An early CT scan may avoid unnecessary anticoagulation in patients without PE, and may help to direct attention to the actual cause.
authors.affiliation: Department of Intensive Care, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Huub
authors.initials: H
authors.lastname: van den Oever
authors.affiliation: Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: John W G M
authors.initials: JW
authors.lastname: Schreurs
authors.affiliation: Department of Haemostasis and Thrombosis, Leiden University, Leiden, The Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: Huisman
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D057210:Delayed Diagnosis / Q000009:adverse effects; D003951:Diagnostic Errors / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004635:Emergency Medicine; D017809:Fatal Outcome; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight