Epidemiology

Risk Factors

• Hemodialysis (see Hemodialysis, [[Hemodialysis]])

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Etiology

Coagulopathy

Acquired Vitamin K Deficiency (see Vitamin K, [[Vitamin K]])

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Anticoagulation

• General Comments: incidence is 0.6-6.6% in the setting of therapeutic anticoagulation
• Coumadin (see Coumadin, [[Coumadin]])
• Factor IIa (Thrombin) Inhibitors (see Factor IIa Inhibitors, [[Factor IIa Inhibitors]])
  • Argatroban (Acova) (see Argatroban, [[Argatroban]])
  • Bivalirudin (Angiomax, Angiox) (see Bivalirudin, [[Bivalirudin]])
  • Dabigatran (Pradaxa) (see Dabigatran, [[Dabigatran]])
  • Desirudin (Iprivask, Revasc) (see Desirudin, [[Desirudin]])
  • Lepirudin (Refludan (see Lepirudin, [[Lepirudin]])
• Factor Xa Inhibitors (see Factor Xa Inhibitors, [[Factor Xa Inhibitors]])
  • Apixaban (Eliquis) (see Apixaban, [[Apixaban]])
  • Betrixaban
  • Danaparoid (Orgaran) (see Danaparoid, [[Danaparoid]])
  • Edoxaban (Lixiana) (see Edoxaban, [[Edoxaban]])
  • Fondaparinux (Arixtra (see Fondaparinux, [[Fondaparinux]])
  • Rivaroxaban (Xarelto) (see Rivaroxaban, [[Rivaroxaban]])
• Heparins
  • Dalteparin (Fragmin) (see Dalteparin, [[Dalteparin]])
  • Enoxaparin (Lovenox) (see Enoxaparin, [[Enoxaparin]])
  • Heparin (Unfractionated) (see Heparin, [[Heparin]])

Antiplatelet Agents

• Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) (see Non-Steroidal Anti-Inflammatory Drug, [[Non-Steroidal Anti-Inflammatory Drug]])
  • Acetylsalicylic Acid (Aspirin) (see Acetylsalicylic Acid, [[Acetylsalicylic Acid]])
  • Other NSAID’s
• Clopidogrel (Plavix) (see Clopidogrel, [[Clopidogrel]])
• Prasugrel (Effient) (see Prasugrel, [[Prasugrel]])
• Ticagrelor (Brilinta) (see Ticagrelor, [[Ticagrelor]])

Coagulopathic Conditions

• Antiphospholipid Antibody Syndrome (see Anti-Phospholipid Antibody Syndrome [[Anti-Phospholipid Antibody Syndrome]])
• Disseminated Intravascular Coagulation (DIC) (see Disseminated Intravascular Coagulation, [[Disseminated Intravascular Coagulation]])
• Factor IX Deficiency (Hemophilia B, Christmas Disease) (see Hemophilia B, [[Hemophilia B]])
• Factor X Deficiency (see Factor X Deficiency, [[Factor X Deficiency]])
• Von Willebrand Disease (see Von Willebrand Disease, [[Von Willebrand Disease]])

IIb/IIIa Inhibitors (see IIb IIIa Inhibitors, [[IIb IIIa Inhibitors]])

• Abciximab (ReoPro) (see Abciximab, [[Abciximab]])
• Eptifibatide (Integrilin) (see Eptifibatide, [[Eptifibatide]])
• Tirofiban (Aggrastat) (see Tirofiban, [[Tirofiban]])

Thrombocytopenia (see Thrombocytopenia, [[Thrombocytopenia]])

• Acute Leukemia Post-Chemotherapy Induction
• Immune Thrombocytopenic Purpura (ITP) (see Immune Thrombocytopenic Purpura, [[Immune Thrombocytopenic Purpura]])
• Thrombotic Thrombocytopenic Purpura (TTP) (see Thrombotic Thrombocytopenic Purpura, [[Thrombotic Thrombocytopenic Purpura]])

Thrombolytics (see Thrombolytics, [[Thrombolytics]])

• Alteplase (see Alteplase, [[Alteplase]])

Iatrogenic

• Femoral Arterial Puncture
  • Cardiac Catheterization: incidence is 0.15%
• Femoral Venous Puncture
  • Central Venous Catheter Placement
• Renal Biopsy
• Trans-Lumbar Aortography

Other

• Hemorrhage from Adrenal Cyst
• Rupture of Abdominal Aortic Aneurysm (AAA) (see Abdominal Aortic Aneurysm, [[Abdominal Aortic Aneurysm]])
• Rupture of Left Inferior Phrenic Artery
• Trauma
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Disgnosis

• Abdominal Ultrasound: may be diagnostic
• Abdominal/Pelvic CT without Contrast: diagnostic

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Clinical Manifestations

Cardiovascular Manifestations

• Hemorrhagic Shock (see Hemorrhagic Shock, [[Hemorrhagic Shock]])

Gastrointestinal Manifestations

• Abdominal Compartment Syndrome (see Abdominal Compartment Syndrome, [[Abdominal Compartment Syndrome]]): may occur in cases with severe retroperitoneal hemorrhage

Other Manifestations

• Back Pain (see Back Pain, [[Back Pain]])
• Femoral/Lumbar Plexus Compressive Neuropathy: may present with lower extremity pain/sensory or motor findings

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Treatment

• Correction of Coagulopathy: usually the mainstay of treatment for coagulopathy-related cases
• Specific Management of Femoral/Lumbar Plexus Compressive Neuropathy
  • Conservative Management
  • Surgical Decompression

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References

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