Belgin KOÇER, Taşkın DUMAN, Özcan ÖZTÜRK

Pectoral muscle hematoma caused by enoxaparin

Bir düşük molekül ağırlıklı heparin olan enoksaparin etkisini trombin aktivitesini inhibe ederek ve antifaktör Xa etkisi göstererek yapar. Majör kanama1, komplikasyon oranı %1.9-6.5 olarak bildirilmiştir. Kronik obstrüktif akciğer hastalığı (KOAH) zemininde pnömoni ve akut solunum yetmezliği ile hastaneye kabul edilen ve nörolojik muayenesinde sol santral fasiyal paralizi ve sol hemiparezi bulunan 90 yaşında bir erkek olgu sunmaktayız. Bilgisayarlı beyin tomografisi normal olan vakada klinik bulgularla aterotrombotik akut iskemik strok tanısı düşünüldü. Enoksaparin subkütan olarak 60 mg (1.5 mg/kg/gün) her 12 saatte bir başlandı. Tedavinin 20'nci gününde sağ pektoral kas üzerinde ağrılı ve hassas kitle lezyonu gelişti. Sağ pektoral kas ultrasonograflsi ve torokal bilgisayarlı tomografide 60x90 mm boyutunda kanama tesbit edildi Enoksaparin tedavisi esnasında iliopsoas ve rektus abdominis kas içi kanama, subdural kanama, spontan hemotoraks ve retroperitoneal kanama gelişen bazı olgular bildirilmiştir. Bununla birlikte pektoral kas içi kanama daha önce bildirilmemiştir.

Enoksaparin tedavisi ile oluşan pektoral kas içi kanama

Enoxaparin, which is a low molecular weight heparin, exerts its effect by inhibiting the activity of thrombin and acting as antifactor Xa. The rate of major hemorrhagic complications during enoxaparin treatment has been reported to be 1.9-6.5%. We present a 90-year-old male patient who had chronic obstructive pulmonary disease (COPD) in his background, who was admitted to hospital with pneumonia and acute respiratory failure. His neurological examination revealed left central facial paralysis with left hemiparesia. His cerebral computed tomography was normal and with his clinical informative data he was diagnosed with atherothrombotic acute ischemic stroke. Enoxaparin 60 mg (1.5 mg/kg/day) subcutaneously every 12 hours was initiated. A painful and tender mass lesion developed on the right pectoral muscle on the 20th day of treatment. Right pectoral muscle ultrasound and thoracal computed tomography revealed a hematoma 60 x 90 mm. There are reports about some patients that have developed hematoma inside the iliopsoas and rectus abdominis muscles, subdural hematoma, spontaneous hemothorax and retroperitoneal hematoma during enoxoparin treatment. However, intrapectoral hemorrhage has not been reported before.

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