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SPONTANEOUS LIVER RUPTURE ASSOCIATED WITH LOW-MOLECULAR-WEIGHT HEPARIN THERAPY
DIANA ŠPOLJAR
orcid.org/0000-0001-5789-113X
; Dubrava University Hospital, Department of Emergency Medicine, Zagreb, Croatia
MAŠA SORIĆ
orcid.org/0000-0002-5002-9800
; Dubrava University Hospital, Department of Emergency Medicine, Zagreb, Croatia
VLATKO GRABOVAC
; Dubrava University Hospital, Department of Emergency Medicine, Zagreb, Croatia
Abstract
We present a rare case of a patient with spontaneous liver rupture, who was treated with anticoagulant therapy due to pulmonary embolism. The patient was diagnosed in the emergency department with deep vein thrombosis of his left leg and bilateral pulmonary embolism. He was admitted to the medical intensive care unit and low-molecular-weight heparin (enoxaparin) therapy was introduced. After the third dose, the patient started complaining of right shoulder and chest pain, and 3 hours later, when the patient was put in the sitting position, there was sharp drop of blood pressure, the patient lost consciousness, stopped breathing and pulse was impalpable. He was resuscitated for 4 minutes, after which he regained consciousness and complained of pain in the right shoulder, chest and right upper abdominal quadrant. Emergency abdominal ultrasonography showed free fl uid in the abdomen, and computed tomography showed liver hemorrhage and liver capsule rupture. The patient was transferred to the operating theater, where liver hemostasis and perihepatic packing were performed. This case report shows the extent of possible adverse effects of anticoagulant therapy, even in patients with short duration of therapy and with no prior blood clotting disorders. Prompt diagnosis and treatment of spontaneous liver rupture are crucial in favorable resolution of this complication.
Keywords
anticoagulant therapy; low-molecular-weight heparin; pulmonary embolism; spontaneous liver rupture
Hrčak ID:
236590
URI
Publication date:
16.3.2020.
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