Subkütan Enoksaparine Bal› Kas ‹çi Hematom

Dufluk molekul a¤›rl›kl› heparinler (DMAH) akut koroner sendrom tedavisinde yayg›n olarak kullan›lmaktad›r. DMAH kullan›m›na bal› en s›k komplikasyon kanamad›r. Nadiren ciddi hemodinamik bozukluklara sebep olabilecek boyutta kanamalar gorulebilmektedir. Ayn› flekil- de subkutan enoksoparin kullan›m› sonras› kas ici hematomla da nadiren karfl›lafl›l›r. Subkutan yerine yanl›fll›kla intramuskuler yap›lan en- jeksiyon sonucunda enjeksiyon bolgesine yak›n bulunan zengin damar anastomozlar› nedeniyle epigastrik damarlar›n hasarlanmas› ve ozel- likle yafll›larda ve artm›fl kanama eilimi olan hastalarda yap›lan antikoagulan›n artm›fl etkisi enoksaparine bal› rektus kas ici hematomu geliflmesinde sorumlu tutulan mekanizmalard›r. Bu yaz›da akut koroner sendrom sebebiyle kar›n bolgesine subkutan enoksaparin uygulanmas› sonucu yayg›n kas ici hematom geliflen bir olgu sunuldu. Anahtar kelimeler: Dufluk molekul a¤›rl›kl› heparin, kas ici hematom, enoksaparin, akut koroner sendrom Cerrahpafla T›p Derg 2010; 41: 26-28 Abstract Low molecular weight heparins (LMWH) are generally used for acute coronary syndrome treatment. Rarely, bleeding associated with LMWH's may lead to severe hemodynamic consequences. Also, intramuscular hematoma may be seen after an accidental injection of enoxaparine intramuscularly (rectus abdominis strain). The disruption of epigastric vessels due to their rich anastomoses nearby the most common injection sites, and pronounced effect of anticoagulation in the elderly and in patients with increased bleeding tendency is sug- gested as a mechanisms of this rare incident. We report a case with a widespread intramuscular hematoma that had developed after injection of subcutaneous enoxaparine to the abdom- inal region for the management of acute coronary syndrome.