Hematoma of the rectus abdominis caused by the application of warfarin sodium and other medicine

Abstract

An 80-year-old male patient with hypertension, arteriosclerosis, rheumatic heart disease, and atrial fibrillation long-term daily oral warfarin sodium 3 mg once daily. International normalized ratio (INR) was maintained at 2.00 to 3.00. An intravenous infusion of piperacillin sodium and tazobactam sodium 4.5 g every 8 hours, intramuscular injection of compound aminophenazone and barbital 2 ml, oral loxoprofen sodium 30 mg and other drugs were added to his regimen for pulmonary infection and high fever. Before the drug combination, prothrombin time (PT) was 27 s, and the INR was 2.45. Two days later, the patient developed hemoptysis. The next day, warfarin sodium was stopped. On the second day of discontinuation of warfarin sodium, the patient suddenly felt a severe pain in the left upper abdomen with the sign of palpable mass and tenderness. Meanwhile, the PT was 42 s, and the INR was 4.46. On the next day, abdominal ultrasound examination showed that there was a cystic structure in the left abdominal rectus muscle with the size of 4.5 cm×2.7 cm×1.5 cm, and the internal circular high density shadow in the left rectus muscle was found on abdominal ultrasonography. Left abdominal rectus muscle hematoma was considered. Intramuscular injection of vitamin K1 10 mg once daily was given immediately, and ceftazidime was used instead of piperacillin sodium and tazobactam sodium. Two days later, the patient's symptoms of abdominal pain disappeared, PT fell to 16 s, INR fell to 1.11. One week later, oral warfarin sodium (initial dose 2.25 mg once daily)was given, and adjusted the dose according to INR. One month later, the abdominal ultrasound examination showed that the size of hematoma significantly decreased (3.5 cm × 0.8 cm). Key words: Warfarin; Rectus abdominis; Hematoma