Posterior Thigh Compartment Syndrome Associated With Hamstring Avulsion and Chronic Anticoagulation Therapy

“…Therefore, it is important to identify all risk factors that can be associated with ACS; early diagnosis and treatment are vital in preventing unfavorable outcomes such as permanent muscular and neurovascular damage, limb amputation, and death [12]. Anticoagulants used for DVT prophylaxis and atrial fibrillation, such as Lovenox® (enoxaparin) [6][7][8][9] and Coumadin® (warfarin) [11], have had published case reports associated with hematomas that lead to ACS in the thigh. To our knowledge, no case reports have been published about compartment syndrome of the thigh while on Eliquis® or recurrent compartment syndrome of the thigh on Eliquis®.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous hematoma associated with bleeding disorders and anticoagulation has also been associated with traumatic and atraumatic lower extremity ACS [5]. Low molecular weight heparin (LMWH) such as Lovenox® (enoxaparin) [6][7][8][9], Marcumar® (phenprocoumon) [10], and Coumadin® (warfarin) [11] has been documented associations with hematomas leading to atraumatic ACS in the thigh. However, published cases of ACS in the thigh with concomitant Eliquis® (apixaban) use have not been cited in current literature.…”

Section: Introductionmentioning

confidence: 99%

A Case of Recurrent Compartment Syndrome with Concomitant Use of Eliquis

Nemunaitis

Haese

Buseck

et al. 2022

Case Reports in Orthopedics

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Introduction. Acute compartment syndrome (ACS) occurs secondary to increasing pressure within a fascial compartment that exceeds perfusion pressure. This can be caused by spontaneous hematomas, which can be secondary to prolonged anticoagulation therapy. Eliquis® has not been associated with ACS of the thigh in any of the currently published literature. Identifying ACS early is important because it can reduce the risk of permanent structural damage, limb amputations, and mortality rates. Case Report. A 43-year-old male with past medical history of unprovoked Deep Vein Thrombosis (DVT) eight months prior to presentation on Eliquis® presented to the emergency department for significant right thigh pain after riding a roller coaster. There was increased tone/firmness of the anterior compartment and tenderness on palpation of the proximal two-thirds of the anterior thigh. Imaging, clinical findings, and Stryker needle measurements confirmed ACS secondary to hematoma, which required fasciotomy and evacuation of the hematoma. The patient was temporarily switched to aspirin for DVT prophylaxis postoperatively to prevent new hematoma formation. Six weeks later, the patient arrived at the ED with a DVT that was treated with Eliquis®. Eight months later, the same patient presented with acute right thigh pain that started while lying in bed. A diagnosis of recurrent ACS in the right anterior thigh was made, requiring a fasciotomy. Surgery was successful without any complications. Discussion. Eliquis® is associated with an increased risk of hematoma formation, which can lead to ACS. This is a rare adverse effect that providers should be aware of because it requires early management to prevent ACS-associated complications. This is significant because no currently published literature has identified an association of Eliquis® with ACS in the thigh. In cases of atraumatic ACS, we were unable to find any protocols advocating for or against the use of DVT prophylaxis postfasciotomy in the literature.

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Compartment Syndrome of the Lower Extremity

Hessmann

Ingelfinger²,

Rommens

2007

Eur J Trauma Emerg Surg

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Acute compartment syndrome of the lower extremity is a limb-threatening emergency that requires prompt surgical treatment. Early detection and decompression are necessary in order to avoid irreversible damage. In the lower extremity, compartment syndrome may occur around the pelvis, in the thigh, the lower leg or the foot. Acute compartment syndrome of the lower leg is most common. Sometimes, combined compartment syndromes of neighbouring skeletal regions are observed. In this review, the specific clinical symptoms as well as the anatomic and therapeutic characteristics of the acute compartment syndrome of the lower extremity are described.

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Posterior Thigh Compartment Syndrome Associated With Hamstring Avulsion and Chronic Anticoagulation Therapy

Cited by 13 publications

References 16 publications

Complete Proximal Hamstring Avulsions

Complete Proximal Hamstring Avulsions

A Case of Recurrent Compartment Syndrome with Concomitant Use of Eliquis

Compartment Syndrome of the Lower Extremity

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