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Discussion

retroperitoneal bleed

I have been taking care of a pt that had a retroperitoneal bleed secondary to Lovenox injection. This is the first time I have heard of this and was wondering how frequently you see this in your practice???

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i assume this was post-op??

  • Author

no post op! pt was transferred from outlying facility with CP; pt started on Lovenox I guess in preparation for intervention that was going to be done here.

gheez, how much Lovenox was he on? Usually if pt's are on a "maintenance" or preventative dose of lovenox it's only 1mg/kg sq bid. If they have a proven clot, like a DVT the dose is higher. What other meds was this guy on? any past history? I've seen plenty of retroperitoneal bleeds but not from Lovenox.

I'm betting this retro-bleed would've happened regardless of what type of anticoagulation he/she was being given. The Lovenox surely made it worse, but it's not some side-effect unique to the drug.

(hey KC, that 1mg/kg bid is a big dose for prophylaxis. We usually give 40mg sq qd for prevention(maybe more if patient weighs alot). The 1mg/kg/bid is more for chest pain/dvt)

i agree w/ the previous post...i have seen a ton of RP bleeds, but they were usually post cath etc....i would guess that there was another pathology re: the bleed and that the lovonox just made it more substantial...

(hey KC, that 1mg/kg bid is a big dose for prophylaxis. We usually give 40mg sq qd for prevention(maybe more if patient weighs alot). The 1mg/kg/bid is more for chest pain/dvt)

I think I was having a brain fart or something, our dose is 30mg. sorry:imbar

i agree w/ the previous post...i have seen a ton of RP bleeds, but they were usually post cath etc....i would guess that there was another pathology re: the bleed and that the lovonox just made it more substantial...
i would like your input on rp bleeds...we had a pat.post angioplasty,not on lovenox,not post cardiaccath,with AAA, PVD,who developed fatal rp bleed
  • Admin

re: allsorts' post: "post angioplasty" to me means post angiogram, which increases risk of rp bleed. Was a closure device used??

re: allsorts' post: "post angioplasty" to me means post angiogram, which increases risk of rp bleed. Was a closure device used??
yes,perclose was used
  • Admin

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.

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
  • Admin

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.

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