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658 - Hematoma’s and Heparin: Spontaneous intramuscular hematomas in the setting of rhabdomyolysis and Anticoagulation

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

OM

Ojirese O. Momoh, DO

Physician
Mercy Hospital
New York, New York, United States

Co-Author(s)

TM

Thomas Moss, DO

Physician
Mercy Hospital
Rockville Centre, New York, United States

Co-Author(s)

LS

Lauren Stimler-Levy, MD

Attending Physician
Mercy Hospital
Rockville Centre, New York, United States

Case Diagnosis: Hematoma in the setting of rhabdomyolysis
Acute blood loss anemia

Case Description:

An 85-year-old male with a history of diabetes, kidney disease, and high cholesterol developed rhabdomyolysis due to statin use. He was admitted to acute inpatient rehabilitation for functional deficits and started on Heparin for DVT prophylaxis. However, he developed an intramuscular hematoma due to anticoagulation and required blood transfusions before stabilizing.

Discussions: Venous thromboembolism, including deep venous thrombosis and pulmonary emboli, is a life-threatening condition. In recent years, increased attention has been paid in the hospital setting to prevent venous thrombosis with prophylactic anticoagulant medications, primarily unfractionated heparin (UFH) and low molecular weight heparin (LMWH). One of the most significant adverse effects of anticoagulant medication is the risk of bleeding, including but not limited to bleeding in the GI tract, retroperitoneal space, and intramuscularly. Rhabdomyolysis is a condition of muscle breakdown correlated with mitochondrial abnormalities, glucose and lipid metabolism, and inflammatory myopathy that may increase the risk of intramuscular hematoma formation. Our case describes an individual with rhabdomyolysis given prophylactic heparin that developed intramuscular hematoma and anemia that resolved after the discontinuation of Heparin and administration of pRBCs.

Conclusions: Healthcare usage of Heparin to prevent venous thromboembolism is of vital importance to prevent DVTs and PEs, however, their use is not without certain risks, specifically bleeding and hematomas. Based on our case study and two other reported cases, patients with rhabdomyolysis have an increased risk of intramuscular hematoma development with the use of chemical DVT prophylaxis with UFH and LMWH. Therefore when administering UFH and LMWH to rhabdomyolysis patients, close monitoring of hemoglobin and physical exam findings must be performed to swiftly catch any instances of hemorrhage and hematoma.