[dianah]

Rp bleed IS one of the possible BIG BAD problems with closure devices. Any time one is used, I am automatically on guard, as it were, for a bleed. They are insidious and often when pt finally has s/sx, it's a HUGE bleed. Esp. if pt has had Lovenox or Plavix or IIB/IIIAs.
I did a quick web search and came up with the following link that may be helpful:
http://nsweb.nursingspectrum.com/ce/ce178.htm

I'm sure there are other sites with good info. Rp is scary.

[allsorts]

Originally Posted by dianah

Rp bleed IS one of the possible BIG BAD problems with closure devices. Any time one is used, I am automatically on guard, as it were, for a bleed. They are insidious and often when pt finally has s/sx, it's a HUGE bleed. Esp. if pt has had Lovenox or Plavix or IIB/IIIAs.
I did a quick web search and came up with the following link that may be helpful:
http://nsweb.nursingspectrum.com/ce/ce178.htm

I'm sure there are other sites with good info. Rp is scary.

thanks for your input-i really appreciate it

[dianah]

Might be worth it to call the vendor rep. of the various closure devices your facility uses, to give an inservice to the nurses who care for pts post-device placement. Then you and others can ask questions directly.

[lalaxton]

i have seen several RP bleeds in patients on Lovenox alone, not post angio. If you read the product monograph it is listed as an adverse effect. I always watch patients carefully for complaints of leg or abd pain. One doc I work with lost his grandmother to a RP bleed on Lovenox that was diagnosed too late!

[RNCENCCRNNREMTP]

I found this info after a quick medline search:

Title
Enoxaparin-induced retroperitoneal hematoma.

Source
Annals of Pharmacotherapy. 37(6):822-4, 2003 Jun.
Abstract
OBJECTIVE: To report 2 cases of retroperitoneal hematoma in elderly patients receiving enoxaparin. CASE SUMMARIES: Two white men, aged 70 and 71 years, received enoxaparin 80 mg subcutaneously twice a day for 8 and 4 days, respectively. Baseline hemoglobin and hematocrit values were 9.5 g/dL and 28.9% and 11.2 g/dL and 32.8%, respectively. In both cases, after the hemoglobin and hematocrit values decreased to 6.6 g/dL and 20.4% and 5.1 g/dL and 15.2%, respectively, a computed tomography scan revealed a retroperitoneal hematoma. DISCUSSION: Enoxaparin is a frequently used anticoagulant. Major bleeding episodes are reported to occur at a rate of up to 5.2%. Factors that increase the risk of bleeding in patients receiving enoxaparin are the use of high doses of enoxaparin, advanced age, renal impairment, and the concomitant use of drugs affecting hemostasis. Both of these patients received relatively high doses of 0.80 and 0.94 mg/kg subcutaneously twice a day, were elderly, and had mild renal impairment; 1 received aspirin concomitantly, while the other received aspirin 4 days prior and warfarin 1 day prior to bleeding. CONCLUSIONS: There are very few published reports implicating enoxaparin as a factor in retroperitoneal hematoma. It is hoped that the addition of these 2 cases to the medical literature creates more awareness that retroperitoneal hematoma should be considered in the differential diagnosis in patients receiving enoxaparin and experiencing unexplained decreases in hemoglobin and hematocrit.

Title
Fatal spontaneous retroperitoneal hematoma secondary to enoxaparin.

Source
Southern Medical Journal. 96(1):58-60, 2003 Jan.
Abstract
An 83-year-old woman was transferred to our cardiac intensive care unit with an acute non-Q-wave myocardial infarction and pulmonary edema. Enoxaparin was one component of the treatment regimen used. Her hospital course was complicated by episodes of hypotension, as well as by recurrent left hip and left thigh pain. The defining event occurred when the patient became acutely hypotensive and developed abdominal distention, peritoneal signs, intense left flank pain, and a 3.3 g/dl hemoglobin decrease. Abdominal computed tomography showed a 9 x 6 x 20 cm left retroperitoneal hematoma. The hematoma was spontaneous, secondary to enoxaparin use. The patient died despite vigorous supportive care. Enoxaparin is being increasingly used in patients with acute coronary syndromes. Review of the medical literature revealed that this is the first reported case of a patient with an acute coronary syndrome who died as a result of an enoxaparin-induced, spontaneous retroperitoneal hematoma. This article reviews important clinical signs and symptoms, identifies high-risk patient populations, and discusses management strategies.

Title
Hemothorax and retroperitoneal hematoma after anticoagulation with enoxaparin.

Source
Southern Medical Journal. 95(8):936-8, 2002 Aug.
Abstract
A 58-year-old woman with chronic obstructive pulmonary disease had spontaneous bilateral hemothorax and a retroperitoneal hematoma after 4 days of anticoagulation therapy with enoxaparin (1 mg/kg subcutaneously every 12 hours) for suspected pulmonary thromboembolism. The patient was successfully managed with red blood cell and plasma transfusions, multiple thoracenteses for evacuation of blood from the pleural space, short-term mechanical ventilation, and administration of bronchodilators, corticosteroids, and antibiotics. This is the first report of spontaneous hemothorax and the third report of spontaneous retroperitoneal hematoma associated with enoxaparin therapy.

[dianah]

I repeat, scary! Be always watching . . .