Venous thromboembolism is seen commonly and preventable disease among cardiovascular syndromes. Embolism is more common in elderly patients and patients with renal failure, with a mortal course and the risk of bleeding is higher (1). Enoxaparin, a member of the Low Molecular Weight Heparin (LMWH) group, is used in the prevention of clot formation such as deep vein thrombosis, pulmonary embolism and the treatment of myocardial infarction (2). Compared to unfractionated heparin, the risk of bleeding, development of osteoporosis and heparin-induced thrombocytopenia are seen lower. Additionally, it is usually preferred firstly instead of heparin due good bioavailability, easy usage and long half-life. Intramuscular bleeding is a serious and mortal complication of anticoagulant treatments (3). Although anterior chest wall bleeding is less than pneumothorax and hemothorax, it occurs commonly in trauma. Spontaneous anterior chest wall bleeding has been reported rarely associated with anticoagulant therapy (4). In this article due to its rarity, threee cases of pectoral hematoma are presented in the light of the literature in the period of anticoagulant use is increasing, especially in co-morbid patients
Case-1
87-year-old male patient with a known history of hypertension and cerebrovascular disease was admitted to the emergency service with dyspnea and general condition disorder. The patient was taken to the intensive care unit with diagnoses of pneumonia and sepsis. LMWH treatment enoksaparine was started as a renal treatment dosage due to having past cerebrovascular event. In the patient who received enoxaparine for 1 month, swelling and pain in the anterior thorax were detected and hematomas of 3 santimeter (cm) on the right and 2,5 cm on the left were detected in the bilateral pectoral region by thorax computed tomography (CT) (Figure 1a). The four erythrocyte suspension transfusions were given for anemia. LMWH treatment was discontinued. After thrombocytopenia were given four fresh frozen plasma. Regression was observed after seven day in the control thorax CT of the patient (Figure 1b). Pneumonia and sepsis progressed. The patient died from septic shock after ten day
Case-2
A 92-year-old female patient with Alzheimer's disease, who did not have oral intake and was fed with a nasogastric tube, was admitted to the emergency department with fever and general condition disorder. The patient was taken to the intensive care unit with starting noninvasive mechanical ventilation due to urinary infection. In the patient with high thrombosis risk, enoxoparine treatment was initiated at a prophylaxis dose. On the 15th day of treatment, 5,5x3 cm hematoma was detected with ultrasonography when swelling was seen in the anterior chest wall. The patient, whose LMWH treatment was discontinued, was followed-up and discharged after ten days.
Case-3
67-year-old male patient was admitted to the internal medicine outpatient clinic with weakness, shortness of breath, and chest pain. Filling defect consistent with pulmonary embolism was detected. The patient was started on enoxaparin therapy at a dosage of 1 miligram/kilogram (2x8000 IU). Higher dose anticoagulant treatment was initiated because the patient's body mass index was over 30. On the seven day of enoxaparine treatment, swelling was detected in the left chest, and a dense content compatible with hematoma with a size of 55x60 mm was detected in the muscle planes of the left pectoral region. Bemiparin treatment, one of the anti factor Xa inhibitors, was started by discontinuing enoxaparin. With the regression of the hematoma, it was continued with oral anticoagulant therapy.