Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin.
Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin.
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DOI：
10.1155/2018/8780121
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发表时间：
2018
影响因子：
0.9
通讯作者：
Tomita S
中科院分区：
文献类型：
--
作者：
Choi BH;Koeckert M;Tomita S
低分子量肝素（LMWH）用于治疗儿科血栓栓塞性疾病的使用越来越多，因为它已被证明是安全和有效的。与普通肝素相比，它有几个优点，如减少监测需求，更容易的给药途径，降低肝素诱导的血小板减少症的风险，以及缺乏药物相互作用。然而，LMWH与任何抗凝治疗一样，仍有出血风险。我们报告一例4岁男孩，在顽固性癫痫发作的情况下，因导管相关深静脉血栓形成而接受低分子肝素治疗，随后发生小肠梗阻，继发于疑似肠套叠。他接受了剖腹探查术，发现有肠壁内血肿。在此出血之前，每天监测患者，发现其抗Xa水平在治疗范围内。该病例强调，即使在治疗性抗Xa水平的情况下，也需要高度怀疑自发性出血。
There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy. We present the case of a 4-year-old boy who was placed on LMWH for a catheter-related deep venous thrombosis in the setting of intractable seizures and subsequently developed a small bowel obstruction secondary to a suspected intussusception. He underwent exploratory laparotomy and was found to have an intramural bowel hematoma. Prior to this bleed, the patient had been monitored daily, and his anti-Xa levels were found to be in the therapeutic range. This case highlights the need for a high index of suspicion for spontaneous bleeding even in the setting of therapeutic anti-Xa levels.