Antiplatelet Therapy and Spontaneous Retroperitoneal Hematoma: A Case Report and Literature Review

Abstract

Patient: Male, 66Final Diagnosis: Spontaneous retroperitoneal hematoma seconday dual antiplatelet therapySymptoms: Anemia • knee joint painMedication: —Clinical Procedure: NoneSpecialty: CardiologyObjective:Rare diseaseBackground:Dual antiplatelet therapy has proven efficacy in primary and secondary prevention of coronary artery disease with a relatively good safety profile. Review of the literature revealed 8 cases of spontaneous retroperitoneal hematoma secondary to antiplatelet treatment.Case Report:We report the case of a 66-year-old male with a flare of acute gout secondary to uncontrolled chronic myeloid leukemia. The patient was started on dual antiplatelet treatment following a drug-eluted stent placement for symptomatic coronary artery disease. He suffered from an unexplained acute drop of five grams of hemoglobin from 10.4 to 5.8 g/dL and symptomatic anemia. The initial labs excluded occult GI bleeding, hemolysis, and bone marrow suppression. However, an abdominal CT scan showed an approximately 7.2×4.7×6.7 cm spontaneous retroperitoneal hematoma involving the left iliacus muscle. The patient was successfully treated conservatively by discontinuing antiplatelet therapy and supportive measures.Conclusions:A spontaneous retroperitoneal hematoma often presents without localizing signs and symptoms and therefore should be considered in any case of unexplained blood loss in patients on antiplatelet therapy. CT without contrast is the modality of choice to diagnose retroperitoneal hematoma.

Spontaneous retroperitoneal haemorrhage post-coronary angioplasty: a case report

“…Only a few cases have been reported in the literature and in most, the patients were on anticoagulants or antiplatelet drugs. 1 Diffuse vasculopathy and atherosclerosis or vasculitis of the small vessels in the retroperitoneum may result in rupture of the most friable vessels and result in diffuse bleeding. Intense cough, forceful vomiting or sneezing may also be responsible for traumatizing the vessels and resulting in bleeding.…”

“…Spontaneous retroperitoneal haemorrhage (SRH) is a rare cause of retroperitoneal haemorrhage that has been described in a few cases who are on anticoagulants or antiplatelet agents or both. 1 It is hypothesized that vasculopathy or unrecognized trauma to small vessels in the retroperitoneum on the background of anticoagulation or antiplatelet agents may result in bleeding in the retroperitoneum. 2 , 3 …”

Retroperitoneal Hemorrhage During Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 Patientss: Clinical Experience and Review of Literature

“…In addition to antithrombotic therapy, other causes of retroperitoneal hemorrhage include trauma and benign and malignant renal tumors 11 . Three cases of retroperitoneal hemorrhage in this report showed multiple diffuse bleeding, and physical shock should be considered rst.…”

Spontaneous Retroperitoneal Hematoma in the Setting of Myasthenic Crisis

“…Spontaneous retroperitoneal and iliopsoas hematomas are associated with a significant mortality increase in the ICU setting, with some studies demonstrating a rate as high as 50% compared to 22% without similar bleeding [1]. Commonly, they are associated with abdominal or pelvic trauma, but are often in the setting of anticoagulation, antiplatelet therapy, iatrogenic causes, known bleeding disorders or vasculitis [2,3]. Frequently, these patients are excessively anticoagulated as demonstrated by routine blood tests, however, some cases occur in the absence of anticoagulation or antiplatelet therapy altogether [4,5].…”