An event is serious (FDA MedWatch definition) when the patient outcome is:

  • death

  • life-threatening

  • hospitalisation

  • disability

  • congenital anomaly

  • requires intervention to prevent permanent impairment or damage

A 74-year-old woman developed a haematoma during prophylactic treatment with heparin for deep vein thrombosis (DVT) after paracentesis; she later died of sepsis.

The woman, who had limited mobility and a history of stroke, underwent diagnostic paracentesis in her right lower quadrant after presenting with abdominal swelling, swelling of her feet and dyspnoea. She started receiving unfractionated heparin 5000U twice daily. On hospital day 5, she experienced severe pain in her right lower quadrant [time to reaction onset not clearly stated]. She had severe dyspnoea, was hypotensive and her haemoglobin had dropped from 9.8 g/dL before paracentesis to 6.8 g/dL. On examination, she had a tender, hard, nonpulsating mass in her right lower quadrant.

The woman was intubated, started receiving vasopressors and was transferred to the ICU. An abdominal CT scan revealed a new haematoma of 9 × 15cm arising from the right rectus sheath and with a mass effect on her uterus and right ureter. She received transfusions with packed RBCs and fresh frozen plasma, to correct coagulopathy and anaemia. A bleeding lateral branch of the epigastric artery was identified by angiography and embolised. She developed renal failure, but refused liver biopsy or surgical evaluation of the haematoma. On repeat CT scan, the haematoma had not resolved. She died of sepsis after an extended ICU-stay.Author Comment“We believe that in our patient the use of heparin for DVT prophylaxis along with trauma associated with paracentesis has resulted in a massive hematoma with hemodynamic compromise.”

FormalPara Key words

Haematoma - adverse reactions - Elderly - drug-induced - Heparin