Retroperitoneal hematoma after use of oral anticoagulants in the postoperative period complicated by atrial fibrillation - A case report

Abstract

One of the elements of therapeutic conduct aimed at avoiding the most severe cardiovascular events such as: heart attack or brain ischemic stroke is the treatment against thrombosis with the use of low molecular weight heparin, anticoagulants and anti - platelet drugs. This therapy is related with bleeding complications, occurring 2 -20% of the patients during treatment with anticoagulants. The aim of this study is to analyze the complications of anticoagulation with oral anticoagulants and low molecular weight heparin in the treatment of cardiac event in the early postoperative period after total hip replacement In 5 day after right THA an event of atrial fibrillation (AF) occurred in 69 year old patient. According to cardiologist recommendation oral anticoagulant was administered to accompany previously used low molecular heparin on the 14th day after surgery. At the moment when the therapeutic dose was achieved the patient presented severe pain which was localized in a right inguinal region and also in a surgically treated hip. The next day it was observed further increase in pain intensity as a right - sided femoral neuralgia accompanied by neurological deficits such as: progressive disorder of sensation on the front surface of the right thigh, weakness right knee reflex muscle, weakness in the active hip flexion and knee extension. In CT and ultrasonography examination the huge retroperitoneal hematoma in a right lumbar-illiac muscle was imaged. Severe hip pain after total hip replacement with progressive symptoms of peripheral nerve lesion obligated to do additional examination in the field of diagnostic imaging of the abdomen and requires a multidisciplinary evaluation. Taking into consideration indications and contraindications and an extensive clinical and laboratory monitoring are crucial conditions to prevent bleeding during anticoagulant therapy.