Lower extremity hematoma as a complication of warfarinization in patients with artificial heart valves

Anticoagulant-Related Intramuscular Hematomas in an Inpatient Acute Rehabilitation Population: A Case Series

ABSTRACT

Anticoagulant-related intramuscular hematomas are uncommon. However, when they do occur, the clinical consequences can be significant. The authors describe nine patients on anticoagulation undergoing rehabilitation who experienced an intramuscular hematoma. In all cases, activity in therapy before the intramuscular hematoma was considered normal therapeutic activity and consistent with activity commonly performed during rehabilitation. The study found that the anticoagulated rehabilitation population is at risk for intramuscular hematomas and poses a diagnostic challenge because many are insensate and, therefore, present atypically.

Hemorrhagic lesions associated with anticoagulant therapy: a pictorial review

Anticoagulant therapy is a treatment that can cause bleeding complications in many anatomical structures. Intracranial, intramuscular and intraabdominal bleeding are internal bleeding that can be secondary to anticoagulated therapy. The prognosis of these hemorrhages can be very good, depending on the anatomical region involved, or they can be fatal. Early recognition of especially intracranial and renal hemorrhages is important for prognosis. For diagnosis, CT and / or MRI should be evaluated according to the region. Internal bleeding should be kept in mind in cases such as sudden hemoglobin decrease or change in consciousness during anticoagulant therapy.

[Ultrasound findings of hamstring hematoma in a patient taking anticoagulants]

A patient started anticoagulation for secondary prevention of stroke, achieving a prothrombin time-international normalized ratio within the optimal therapeutic range. The patient subsequently complained of pain in the left thigh on hospital day 25, and ultrasonography showed a large intramuscular hematoma in the left hamstring. The intramuscular hematoma gradually reduced without surgical intervention. Ultrasound examination plays an important role in precisely diagnosing intramuscular hematoma and monitoring changes in hematoma size.

Hématomes cutanés et sous-cutanés vus en dermatologie : 17 cas

INTRODUCTION

Cutaneous hematomas are a cause of hospitalization in departments of dermatology. Their clinical diagnosis can be difficult, particularly since they can masquerade as thrombophlebitis or abscesses. We conducted a retrospective study so as to specify their frequency, clinical aspects and circumstances of occurrence.

PATIENTS AND METHODS

The search for hospitalizations was conducted, using a computer data coding and key word "hematoma", from January 1997 to March 2003. The following items were studied: age, gender, clinical aspect on admission, topography, use of anti-platelets or anticoagulants, the existence of documented overdosing, treatment before hospitalization and existence of fever.

RESULTS

The 17 patients hospitalized for hematomas were 9 women and 8 men with a mean age of 71 years. Thirteen patients were treated with: antivitamin K (5 cases), low molecular weight heparin (3 cases), anti-platelets (4 cases), or a combination of antivitamin K and anti-platelets (1 case). Four patients had no antivitamin K or anti-platelet treatment; their coagulation control was normal and they were younger than the patients taking a treatment (55 versus 76 years). The hematomas always involved the lower limbs. The clinical aspect was: simple hematoma (3 cases), inflammatory or over-infected hematoma (11 cases) and post-hematoma ulceration (3 cases). Seven patients were febrile either before or during their hospitalization. A context of trauma was noted in 10 patients. In the 9 patients treated with antivitamin K or low molecular weight heparin, overdosing was documented in 5. The treatments received before hospitalization were: general antibiotherapy (7 cases), local antibiotherapy (1 case) and low molecular weight heparin (7 cases).

DISCUSSION

Hematomas of the legs usually occur in elderly patients, treated with anticoagulants or anti-platelets. They present in the form of ecchymotic tumefaction, frequently inflammatory or febrile. Therapeutic overdosing is common. The ratio with the erysipelas hospitalized in our department is of 1/8; over the past 5 years we have observed a mean of 3 cases per year. Hence they are not uncommon and dermatologists must be aware of their clinical aspects and the circumstances in which they occur.