Yatak Başı Acil Ultrasonografi ile Tespit Edilen Warfarine Bağlı İliopsoas Hematonu

Warfarin is frequently used as an oral anticoagulant in a variety of clinical settings, e.g. atrial fibrillation or following valvular heart disease. The most serious and common complication associated with anticoagulation using warfarin is bleeding. Hemorrhage into the iliopsoas muscle causing femoral neuropathy is an infrequent complication of anticoagulant therapy. Two women, 53 and 70 year-old, each with a history of mitral valve replacement surgery, presented at the emergency department with right hip pain. They had been taking warfarin 5 mg once a day since their operations. Physical examinations were normal except for the right hip pain,on movement and femoral nerve palsy in the second patient. Prothrombin, activated prothrombin time and international normalized ratio were prolonged. In order to make the differential diagnosis, we decided to perform bedside emergency ultrasound examination. Ultrasound examination of the patients showed an anechoic lesion in the area of the right iliopsoas muscle. They were admitted to hospital for observation and treatment. Fresh frozen plasma and vitamin K were given for treatment. The possibility of iliopsoas hematoma should be considered in any patient with hip pain undergoing anticoagulant treatment.

Anahtar Kelimeler:

Iliopsoas hematoma, warfarin, anticoagulant therapy

Warfarin Induced Iliopsoas Hematoma Detected by Bedside Emergency Ultrasonography

Keywords:

Iliopsoas hematoma, warfarin, anticoagulant therapy,

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Gallus AS, Baker RI, Chong BH, Ockelford PA, Street AM. Con- sensus guidelines for warfarin thera-py. Recommendations from the Australasian Society of Thrombosis and Haemostasis. Med J Aust. 2000; 172: 600-5.
Parmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME. Femoral neuropathy following retroperitoneal hemorrhage: case series and review of the literature. Ann Vasc Surg. 2006; 20: 536-40. [CrossRef]
Cronin CG, Lohan DG, Meehan CP, Delappe E, McLoughlin R, O’Sullivan GJ, et al. Anatomy, patho-logy, imaging and interven- tion of the iliopsoas muscle revisited. Emerg Radiol. 2008; 15: 295-310. [CrossRef]
Ong HS. Compressive femoral neuropathy: a rare complication of anticoagulation. Singapore Med J. 2007; 48: e94-5.
Seijo-Martinez M, Castro del Rio M, Fontoira E, Fontoira M. Acute femoral neuropathy secondary to an iliacus muscle hema- toma. J Neurol Sci. 2003; 209: 119-22. [CrossRef]
Cruickshank J, Ragg M, Eddey D. Warfarin toxicity in the emer- gency department: Recommendati-ons for management. Emerg Med (Fremantle). 2001; 13: 91-7. [CrossRef]
Wada Y, Yanagihara C, Nishimura Y. Bilateral iliopsoas hemato- mas complicating anticoagulant therapy. Intern Med. 2005; 44: 641-3. [CrossRef]
Marquardt G, Barduzal Angles S, Leheta F, Seifert V. Spontane- ous haematoma of the iliac psoas muscle: a case report and review of the literature. Arch Orthop Trauma Surg. 2002; 122: 109-11. [CrossRef]
Kwon OY, Lee KR, Kim SW. Spontaneous iliopsoas muscle hae- matoma. Emerg Med J. 2009; 26: 863. [CrossRef]