Masivni retroperitoneumski hematom kao komplikacija antikoagulantne terapije kod bolesnika lečenog u pulmološkoj jedinici intenzivne nege

  • Mihailo Stjepanović Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
  • Ivana Buha Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
  • Snežana Raljević Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Uroš Babić Clinic of Urology, Clinical Center of Serbia, Belgrade, Serbia
  • Milan Savić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Jovana Mašković Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
  • Marina Roksandić Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
  • Dragana Marić Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/4531
Ključne reči: anticoagulants||, ||antikoagulansi, drug toxicity||, ||lekovi, toksičnost, hemorrhage||, ||krvarenje, hematoma||, ||hematom, retroperitoneal space||, ||retroperitonealni prostor, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Retroperitoneumski hematom može nastati kao rezultat traume, rupture aneurizme arterije (aortne ili ilijačne), hirurške komplikacije, tumora ili antikoagulantne terapije. Prikaz bolesnika. Prikazali smo bolesnika na trajnoj antikoagulantnoj terapiji koji je na dan prijema u našu ustanovu imao vrednost INR 5,57. Odmah je obustavljena antikoagulantna terapija. Bolesnik je od tegoba navodio i bolove u desnom ingvinalnom kanalu koji su zračili duž desne noge, što se uklapalo u kliničku sliku spontanog retroperitonumsku hematoma. Posle tri dana došlo je do sniženja nivoa hemoglobina, tako da je primenjena dopunska dijagnostika. U nalazu dobijenom kompjuterizovanom tomografijom abdomena opisan je dobro ograničen retroperitoneumski hematom velikih dimenzija (213 ´ 79 ´ 91 mm). Primenjena je transfuzija koncentrovanih eritrocita koja je dovela do zadovoljavajuće korekcije nivoa hemoglobina. Bolesnik je dobio i četiri jedinice sveže smrznute plazme. Nakon što je hemodinamski stabilizovan, otpušten je iz jedinice intenzivne nege, posle dvomesečnog lečenja. Savetovano mu je da zbog perzistentne artimije koristi niskomolekulski heparin 2 ´ 0,4 mg potkožno. Zaključak. Kod bolesnika na antikoagulantnoj terapiji izuzetno je značajno redovno praćanje njihovog antikoagulantnog statusa, upravo zbog razvoja ponekad i fatalnih komplikacija, kao što je spontani retroperitonealni hematom.

 

Biografije autora

Mihailo Stjepanović, Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
Doktor medicine, akademski spec. pulmologije
Ivana Buha, Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
Snežana Raljević, Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Milan Savić, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
Jovana Mašković, Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
Marina Roksandić, Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
Dragana Marić, Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Reference

Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma 1985; 25(11): 1021−9.

Danaci M, Kesici GE, Kesici H, Polat C, Belet U. Coumadin-induced renal and retroperitoneal hemorrhage. Ren Fail 2006; 28(2): 129−32.

Pallea EX, Domingo P, Fontcubertta J, Felez J. Spontaneus terto-peritoneal haemorrhage during oral anticoagulant therapy. Arch Inrern Med 1985; 145(8): 1531−4.

Hirsh J, Dalen JE, Anderson DR, Poller L, Bussey H, Ansell J, et al. Oral anticoagulants: mechanism of action, clinical effec-tiveness, and optimal therapeutic range. Chest 2001; 119: 8S−21S.

The European Atrial Fibrillation Tril Study Group. Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fi-brillation and recent cerebral ischemia. N Engl J Med 1995; 333: 5−10.

Hylek EM, Chang YC, Skates SJ, Hughes RA, Singer DE. Pros-pective study of outcomes of ambulatory patients with exces-sive Warfarin anticoagulation. Arch Inter Med 2000; 160(11): 1612−7.

Balci NC, Sirvanci M, Tüfek I, Onat L, Duran C. Spontaneous re-troperitoneal hemorrhage secondary to subcapsular renal he-matoma: MRI findings. Magn Reson Imaging 2001;19(8):1145-8.

Kirazli Y, Akkoc Y, Kanyilmaz S. Spinal epidural hematoma as-sociated with oral anticoagulation therapy. Am J Phys Med Rehabil 2004; 83(3): 220−3.

Crowther MA, Warkentin TE. Bleeding risk and the manage-ment of bleeding complications in patients undergoing anti-coagulant therapy: focus on new anticoagulant agents. Blood 2008; 111(10): 4871−9.

Sasson Z, Mangat I, Peckham KA. Spontaneous iliopsoas hema-toma in patients with unstable coronary syndromes receiving intravenous heparin in therapeutic doses. Can J Cardiol 1996; 12(5): 490−4.

Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30(2): 239−45.

Pless T, Loertzer H, Brandt S, Radke J, Fornara P, Soukup J. Atraumatic retroperitoneal hemorrhage: interdisciplinary and differential diagnostic considerations based on a case report. Anaesthesial Reanim 2003; 28(2): 50−3. (German)

Quartey B, Nelson J. Massive spontaneous retroperitoneal he-morrhage induced by enoxaparinand subsequent abdominal compartment syndrome requiring surgical decompression: a case report and literature review. IJCRI 2011; 2(10): 14−8.

Dentali F, Crowther M. Management of excessive anticoagulant effect due to vitamin K antagonists. Hematology Am Soc Hematol Educ Program 2008; 2008: 266−70.

Baglin T. Management of warfarin (coumarin) overdose. Blood Rev 1998; 12(2): 91−8.

Lubetsky A, Yonath H, Olchovsky D, Loebstein R, Halkin H, Ezra D. Comparison of oral vs intravenous phytonadione (vitamin K1) in patients with excessive anticoagulation: a prospective randomized controlled study. Arch Intern Med 2003; 163(20): 2469−73.

Ivascu FA, Janczyk RJ, Bair HA, Bendick PJ, Howells GA. Sponta-neous retroperitoneal hemorrhage. Am J Surg 2005; 189(3): 345−7.

Daliakopoulos SI, Bairaktaris A, Papadimitriou D, Pappas P. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report. J Med Case Rep 2008; 2(1): 162.

Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 6 (2015)
Rubrika
Prikaz bolesnika