Spontaneous Hematoma of the Rectus Abdominis Muscle During Treatment with Non-vitamin K Oral Anticoagulant: A Rare Clinical Occurrence and Review of the Literature
P. M. Mulendele
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
S. Halim
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. Njie *
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. S. Boutar
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
A. Assklou
Hospital Practician Attaché, Ibn Rochd University Hospital, Casablanca, Morocco.
M. Haboub
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II university of Casablanca, Casablanca, Morocco.
G. M. Benouna
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II university of Casablanca, Casablanca, Morocco.
A. Drighil
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II university of Casablanca, Casablanca, Morocco.
R. Habbal
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II university of Casablanca, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Vitamin k antagonist anticoagulants (VKAs) and non-vitamin K oral anticoagulants (NOACs) are widely used in the treatment of non-valvular atrial fibrillation and other indications, but both classes of medications carry a risk of potentially serious bleeding. Spontaneous hematoma of the rectus abdominis muscle is a rare complication of NOAC treatment. Several risk factors, such as trauma, surgery, anticoagulation, coughing, intense rectus muscle contractions, pregnancy, etc., have been reported to cause rectus sheath hematoma. We report a case of spontaneous hematoma of the rectus abdominis muscle associated with moderate hemoperitoneum in a patient treated with NOAC for non-valvular atrial fibrillation (AF). Abdominal ultrasound and computed tomography scan (CT scan) confirmed the diagnosis after clinical assessment. The treatment was generally conservative but in the case of a hemodynamically unstable patient; hemostatic procedures should be considered.
Keywords: Spontaneous hematoma, non-vitamin k oral anticoagulant, hemoperitoneum