Abstract In Reply.— Attention to the proper technique of subcutaneous injection of heparin is important to avoid development of a cJinicaUy significant intramuscular hematoma. In his letter, Thomas gives some suggestions for the administration of subcutaneous heparin that are reasonable and may help avert such complications.Morrison raises concerns about the use of the thigh as a site for subcutaneous injection of heparin. He cites anatomic reasons that might make injection in the thigh more hazardous than injection in the abdomen.1 It is unclear, however, to what extent the observations and case reports that he cites can be generalized to patients receiving low-dose prophylactic heparin. In cited series,1 heparin was administered therapeutically and doses ranged from 50 to 75 mm every 6 hours (5000 to 7500 U every 6 hours), which are higher than prophylactic doses and likely result in therapeutic anticoagulation. Systemic anticoagulation can cause development of both retroperitoneal References 1. Morrison FS, Wurzel HA. Retroperitoneal hemorrhage during heparin therapy . Am J Cardiol. 1964;13:329-332.Crossref 2. 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. 3. Teske JM. Hematoma of rectus abdominis muscle: report of case and analysis of 100 cases from literature . Am J Surg. 1946;71:689-695.Crossref 4. Schafer CS. Rupture of the rectus abdominis muscle and deep epigastric arteries: a review of 100 collective cases, with the report of one case . Am J Surg. 1953;86:157-160.Crossref 5. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma . Am J Surg. 1972;124:80-86.Crossref 6. Ducatman BS, Ludwig J, Hurt RD. Fatal rectal sheath hematoma . JAMA. 1983;249:924-925.Crossref 7. Tsapatsaris NP. Low-dose heparin: a cause of hematoma of rectus abdominis . Arch Intern Med. 1991;151:597-599.Crossref
Archives of Internal Medicine – American Medical Association
Published: Jan 1, 1992
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