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25 January 2017 : Case report  USA

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

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Walid Ibrahim12EF*, Abdelaziz Mohamed2E, Muhammed Sheikh12E, Mohamed Shokr12E, Abubaker Hassan12E, Jarrett Wienberger12E, Luis C. Afonso23E

DOI: 10.12659/AJCR.901622

Am J Case Rep 2017; 18:85-89

Abstract

BACKGROUND: 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.

Keywords: Aspirin, Hematoma, Platelet Aggregation Inhibitors, Retroperitoneal Space

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923