IMR Press / RCM / Volume 21 / Issue 3 / DOI: 10.31083/j.rcm.2020.03.153
Open Access Case Report
Enoxaparin related spontaneous fatal retroperitoneal hemorrhage in a patient with atrial fibrillation
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1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
*Correspondence: (Youngok Lee)
Rev. Cardiovasc. Med. 2020, 21(3), 469–471;
Submitted: 26 July 2020 | Revised: 12 September 2020 | Accepted: 16 September 2020 | Published: 30 September 2020
Copyright: © 2020 Oh et al. Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Spontaneous retroperitoneal hemorrhage (SRH) is a potentially lethal complication of anticoagulation therapy. The signs and symptoms vary from clinical silence to abdominal pain or hemorrhagic shock. The diagnosis of SRH may be difficult, especially in its early clinical course, due to its varied symptoms. Physicians need to have a high degree of suspicion for its early diagnosis. Delayed diagnosis of SRH can lead to serious complications or death. Bleeding complications in anticoagulated patients are well known; however, reports about SRH with fatal outcomes are sporadic. Here, we describe a case of massive SRH in a patient receiving enoxaparin. In our case, the patient died due to delayed diagnosis and treatment. We, therefore, emphasize that physicians should always consider SRH in any patient receiving anticoagulants who presents with abdominal pain.

Anticoagulant agents
perioperative period
retroperitoneal space
Fig. 1.
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