[Hematoma of the rectus abdominis as a complication of anticoagulant therapy with subcutaneously administered heparin calcium]. / Ematoma del muscolo retto addominale quale complicanza della terapia anticoagulante con eparina calcica s.c.

ABSTRACT

The use of anticoagulant therapy with subcutaneous heparin calcium has long become an established routine for both arterial and venous pathologies. However, albeit with a lower percentage than in intravenous anticoagulant therapy, it is not free from complications. The authors report their experience regarding two cases of hematoma of the rectus abdominis muscle that occurred after anticoagulant treatment with full dose subcutaneous heparin calcium in patients suffering from severe chronic obliterating arterial disease of the lower limbs. From a diagnostic point of view, in addition to the clinical examination of the patient, which often does not results in the decisive confirmation of diagnosis, ultrasound and computerized tomography are essential not only to confirm the suspected diagnosis but also to monitor the evolution of the hematoma over time. In both cases the hematoma resolved spontaneously following gradual resorption, although treatment, especially in cases in which the hematoma is not blocked by the suspension of anticoagulant therapy, may include surgical draining. In view of the frequency with which this treatment is used in arteriopathic or phlebopathic subjects, including elderly patients who may present concauses for the formation of a hematoma of the rectus abdominis muscle (connectivitis, chronic or acute renal insufficiency, hemodyscrasia in terms of hypocoagulation), the authors suggest that high-risk patients should be identified for the possible use of an alternative route of administration.