Page 27 - Delaware Medical Journal - February 2018

CASE REPORT
in blood counts found in serial measurements. Generally, the current indications for low-molecular weight heparin 30 mg every 12 hours are limited to deep venous thrombosis prophylaxis following knee replacement surgery and hip replacement surgery. These doses are maintained for seven to ten days postoperatively. Similar indications are available with different doses, most notably following abdominal surgery, where dosing is limited to 40 milligrams daily. As alluded to, there are no current indications for such doses in the setting of bleeding and thrombosis.
CONCLUSION
In a patient taking long-term anticoagulation for recurrent venous thromboses, one must have a strong index of suspicion for adrenal hemorrhage in the setting of generalized abdominal pain. Though heparin has been shown to be an independent risk factor, this unusual case highlights a potentially grave side-effect of apixaban that can easily be overlooked. The use of NOACs could result in
REFERENCES
antidotes. If further inpatient management is indicated, a close assessment of the clinical context and further risk factors must be assessed prior to re-administration of anticoagulant medication, if needed. Our patient’s concurrent bleed and thrombus was successfully managed using an off-label dose of low-molecular weight heparin.
CONTRIBUTING AUTHORS
■ STEPHEN LAZAR, DO is a third-year Internal Medicine Resident with Inspira Health Network in Vineland, NJ.
■ SHAILJA ROY, MD is Board-Certified in Internal Medicine, Hematology, and Medical Oncology and practices with Southern Oncology Hematology Associates in Vineland, NJ.
■ KUSH SACHDEVA, MD is Board-Certified in Internal Medicine, Hematology, and Medical Oncology and practices with Southern Oncology Hematology Associates in Vineland, NJ.
■ LIN ZHENG, MD is a hospitalist who practices with Cooper University Health System in Camden, NJ.
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