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Low-Dose Heparin: A Cause of Hematoma of Rectus Abdominis

Low-Dose Heparin: A Cause of Hematoma of Rectus Abdominis Abstract Although hematomas of the rectus abdominis muscle are commonly reported complications of systemic anticoagulation treatment, they are a rare complication of prophylactic adminadministratitrationlow-dosecurrence of a massive hematomathe rectus sheath is reported in a woman with chronic obstructive pulmonary disease and acute respiratory failure who was receiving low doses of heparin for the prevention of deep venous thrombosis. Three other cases of hematoma of the rectus sheath resulting from prophylactic use of heparin are reviewed. The development of hematoma in these patients may have resulted from intramuscular abdominal injection of heparin and from strain of the rectus abdominis muscle caused by coughing. When prophylactic administration of heparin is necessary in patients with a tendency to paroxysmal cough, subcutaneous injections of heparin in the thigh may be preferable to subcutaneous injections in the abdomen. (Arch Intern Med. 1991;151:597-599) References 1. Kakkar VV, Corrigan TP, Fossard DP, et al. Prevention of fatal postoperative pulmonary embolism by low doses of heparin: an international multicentre trial . Lancet . 1975;2:45-51. 2. Gallus AS, Hirsh J, Tuttle RJ, et al. Small subcutaneous doses of heparin in prevention of venous thrombosis . N Engl J Med. 1973;288:545-551Crossref 3. Warlow C, Terry G, Kenmure ACF, Beattie AG, Ogston D, Douglas AS. A double-blind trial of low doses of subcutaneous heparin in the prevention of deep-vein thrombosis after myocardial infarction . Lancet. 1973;2:934-936.Crossref 4. Pingleton SK, Bone RC, Pingleton WW, Ruth WE. Prevention of pulmonary emboli in a respiratory intensive care unit: efficacy of low-dose heparin . Chest. 1981;79:647-650.Crossref 5. van Ooijen B. Subcutaneous heparin and postoperative wound hematomas: a prospective, double-blind, randomized study . Arch Surg. 1986;121:937-940.Crossref 6. Rankin JA. Heparin-induced thrombosis (white clot syndrome) secondary to prophylactic subcutaneous administration of heparin . Can J Surg. 1988;31:33-34. 7. White PW, Sadd JR, Nensel RE. Thrombotic complications of heparin therapy: including six cases of heparin-induced skin necrosis . Ann Surg. 1979;190:595-608.Crossref 8. Tuneu A, Moreno A, de Moragas JM. Cutaneous reactions secondary to heparin injections . J Am Acad Dermatol. 1985;12:1072-1077.Crossref 9. Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma . JAMA. 1983;249:924-925.Crossref 10. Sturgess AD, Marwick TH. Abdominal wall haematoma related to prophylactic heparin therapy . Practitioner. 1986;230:845-846. 11. Webb KB, Hadzima S. Hematoma of the rectus abdominis muscle: a complication of subcutaneous heparin therapy . South Med J. 1987;80:911-912.Crossref 12. Schafer CS. Rupture of the rectus abdominis muscle and deep epigastric arteries: a review of 100 collected cases, with the report of one case . Am J Surg. 1953;86:157-160.Crossref 13. Teske JM. Hematoma of the rectus abdominis muscle: report of a case and analysis of 100 cases from the literature . Am J Surg. 1946;71:689-695.Crossref 14. Titone C, Lipsius M, Krakauer JS. 'Spontaneous' hematoma of the rectus abdominis muscle: critical review of 50 cases with emphasis on early diagnosis and treatment . Surgery 1972;72:568-572. 15. Cullen TS. Lesions of rectus abdominis muscle simulating acute intraabdominal condition: hemorrhage into or beneath rectus muscle simulating acute abdominal condition . Bull Johns Hopkins Hosp. 1937;61:317-348. 16. Jones TW, Merendino KA. The deep epigastric artery: rectus muscle syndrome . Am J Surg. 1962;103:159-169.Crossref 17. Manier JW. Rectus sheath hematoma: six case reports and a literature review . Am J Gastroenterol. 1972;57:443-452. 18. Babb RR, Spittell JA Jr, Bartholomew LG. Hematoma of the rectus abdominis muscle complicating anticoagulant therapy . Mayo Clin Proc. 1965;40:760-765. 19. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma . Am J Surg. 1972;124:80-86.Crossref 20. Bergqvist D. Postoperative Thromboembolism: Frequency, Etiology, Prophylaxis . New York, NY: Springer-Verlag NY Inc; 1983:104-105. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Low-Dose Heparin: A Cause of Hematoma of Rectus Abdominis

Archives of Internal Medicine , Volume 151 (3) – Mar 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400030127024
Publisher site
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Abstract

Abstract Although hematomas of the rectus abdominis muscle are commonly reported complications of systemic anticoagulation treatment, they are a rare complication of prophylactic adminadministratitrationlow-dosecurrence of a massive hematomathe rectus sheath is reported in a woman with chronic obstructive pulmonary disease and acute respiratory failure who was receiving low doses of heparin for the prevention of deep venous thrombosis. Three other cases of hematoma of the rectus sheath resulting from prophylactic use of heparin are reviewed. The development of hematoma in these patients may have resulted from intramuscular abdominal injection of heparin and from strain of the rectus abdominis muscle caused by coughing. When prophylactic administration of heparin is necessary in patients with a tendency to paroxysmal cough, subcutaneous injections of heparin in the thigh may be preferable to subcutaneous injections in the abdomen. (Arch Intern Med. 1991;151:597-599) References 1. Kakkar VV, Corrigan TP, Fossard DP, et al. Prevention of fatal postoperative pulmonary embolism by low doses of heparin: an international multicentre trial . Lancet . 1975;2:45-51. 2. Gallus AS, Hirsh J, Tuttle RJ, et al. Small subcutaneous doses of heparin in prevention of venous thrombosis . N Engl J Med. 1973;288:545-551Crossref 3. Warlow C, Terry G, Kenmure ACF, Beattie AG, Ogston D, Douglas AS. A double-blind trial of low doses of subcutaneous heparin in the prevention of deep-vein thrombosis after myocardial infarction . Lancet. 1973;2:934-936.Crossref 4. Pingleton SK, Bone RC, Pingleton WW, Ruth WE. Prevention of pulmonary emboli in a respiratory intensive care unit: efficacy of low-dose heparin . Chest. 1981;79:647-650.Crossref 5. van Ooijen B. Subcutaneous heparin and postoperative wound hematomas: a prospective, double-blind, randomized study . Arch Surg. 1986;121:937-940.Crossref 6. Rankin JA. Heparin-induced thrombosis (white clot syndrome) secondary to prophylactic subcutaneous administration of heparin . Can J Surg. 1988;31:33-34. 7. White PW, Sadd JR, Nensel RE. Thrombotic complications of heparin therapy: including six cases of heparin-induced skin necrosis . Ann Surg. 1979;190:595-608.Crossref 8. Tuneu A, Moreno A, de Moragas JM. Cutaneous reactions secondary to heparin injections . J Am Acad Dermatol. 1985;12:1072-1077.Crossref 9. Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma . JAMA. 1983;249:924-925.Crossref 10. Sturgess AD, Marwick TH. Abdominal wall haematoma related to prophylactic heparin therapy . Practitioner. 1986;230:845-846. 11. Webb KB, Hadzima S. Hematoma of the rectus abdominis muscle: a complication of subcutaneous heparin therapy . South Med J. 1987;80:911-912.Crossref 12. Schafer CS. Rupture of the rectus abdominis muscle and deep epigastric arteries: a review of 100 collected cases, with the report of one case . Am J Surg. 1953;86:157-160.Crossref 13. Teske JM. Hematoma of the rectus abdominis muscle: report of a case and analysis of 100 cases from the literature . Am J Surg. 1946;71:689-695.Crossref 14. Titone C, Lipsius M, Krakauer JS. 'Spontaneous' hematoma of the rectus abdominis muscle: critical review of 50 cases with emphasis on early diagnosis and treatment . Surgery 1972;72:568-572. 15. Cullen TS. Lesions of rectus abdominis muscle simulating acute intraabdominal condition: hemorrhage into or beneath rectus muscle simulating acute abdominal condition . Bull Johns Hopkins Hosp. 1937;61:317-348. 16. Jones TW, Merendino KA. The deep epigastric artery: rectus muscle syndrome . Am J Surg. 1962;103:159-169.Crossref 17. Manier JW. Rectus sheath hematoma: six case reports and a literature review . Am J Gastroenterol. 1972;57:443-452. 18. Babb RR, Spittell JA Jr, Bartholomew LG. Hematoma of the rectus abdominis muscle complicating anticoagulant therapy . Mayo Clin Proc. 1965;40:760-765. 19. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma . Am J Surg. 1972;124:80-86.Crossref 20. Bergqvist D. Postoperative Thromboembolism: Frequency, Etiology, Prophylaxis . New York, NY: Springer-Verlag NY Inc; 1983:104-105.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1991

References