Therapeutic anticoagulation complications in the elderly: a case report
Abstract Background The demographic transition leads to a continuously growing number of elderly patients who receive therapeutic anticoagulation by reason of several comorbidities. Though therapeutic anticoagulation may reduce the number of embolic complications in these patients, major complicatio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-022-02781-6 |
| _version_ | 1818500881755144192 |
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| author | Marcel Niemann Karl F. Braun Sufian S. Ahmad Christian Eder Ulrich Stöckle Frank Graef |
| author_facet | Marcel Niemann Karl F. Braun Sufian S. Ahmad Christian Eder Ulrich Stöckle Frank Graef |
| author_sort | Marcel Niemann |
| collection | DOAJ |
| description | Abstract Background The demographic transition leads to a continuously growing number of elderly patients who receive therapeutic anticoagulation by reason of several comorbidities. Though therapeutic anticoagulation may reduce the number of embolic complications in these patients, major complications such as bleeding complications need to be kept in mind when considering such therapy. However, evidence regarding the choice of anticoagulation agents in chronic kidney disease patients of higher age is limited. In this report, a guideline-based anticoagulation treatment which led to a fulminant atraumatic bleeding complication is discussed. Case presentation We present the case of an 85-year-old female stage V chronic kidney disease patient who suffered from a diffuse arterial, subcutaneous bleeding in her lower left leg due a therapeutic anticoagulation using low molecular weight heparin (LMWH). Anticoagulation was started in accordance with general recommendations for patients with atrial fibrillation, and the dosage was adapted for the patient’s renal function. Nevertheless, the above-mentioned complication occurred, and the bleeding led to a hemorrhagic shock and an acute kidney injury on top of a chronic kidney disease. The hematoma required surgical evacuation and local coagulation in the operating room. In the further course, the patient underwent additional four surgical interventions due to a superinfected skin necrosis, including skin grafting. Furthermore, the patient needed continuous renal replacement therapy, as well as intensive care unit treatment, for a total of 47 days followed by 36 days of geriatric rehabilitation. Afterwards, she was discharged from the hospital to her previous nursing home. Discussion and conclusions Although therapeutic anticoagulation may sufficiently protect patients at cardiovascular risk, major complications such as bleeding complications may occur at any time. Therefore, physicians need to regularly re-evaluate any prior indication for therapeutic anticoagulation. With this case report, we hope to draw attention to the cohort of geriatric patients and the need for more and well differentiated study settings to preferably prevent any potentially avoidable complications. |
| first_indexed | 2024-12-10T20:48:40Z |
| format | Article |
| id | doaj.art-ee5756a60a504203a4684bea12d2cd6c |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-10T20:48:40Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-ee5756a60a504203a4684bea12d2cd6c2022-12-22T01:34:10ZengBMCBMC Geriatrics1471-23182022-02-012211510.1186/s12877-022-02781-6Therapeutic anticoagulation complications in the elderly: a case reportMarcel Niemann0Karl F. Braun1Sufian S. Ahmad2Christian Eder3Ulrich Stöckle4Frank Graef5Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCharité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCharité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCharité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCharité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCharité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthAbstract Background The demographic transition leads to a continuously growing number of elderly patients who receive therapeutic anticoagulation by reason of several comorbidities. Though therapeutic anticoagulation may reduce the number of embolic complications in these patients, major complications such as bleeding complications need to be kept in mind when considering such therapy. However, evidence regarding the choice of anticoagulation agents in chronic kidney disease patients of higher age is limited. In this report, a guideline-based anticoagulation treatment which led to a fulminant atraumatic bleeding complication is discussed. Case presentation We present the case of an 85-year-old female stage V chronic kidney disease patient who suffered from a diffuse arterial, subcutaneous bleeding in her lower left leg due a therapeutic anticoagulation using low molecular weight heparin (LMWH). Anticoagulation was started in accordance with general recommendations for patients with atrial fibrillation, and the dosage was adapted for the patient’s renal function. Nevertheless, the above-mentioned complication occurred, and the bleeding led to a hemorrhagic shock and an acute kidney injury on top of a chronic kidney disease. The hematoma required surgical evacuation and local coagulation in the operating room. In the further course, the patient underwent additional four surgical interventions due to a superinfected skin necrosis, including skin grafting. Furthermore, the patient needed continuous renal replacement therapy, as well as intensive care unit treatment, for a total of 47 days followed by 36 days of geriatric rehabilitation. Afterwards, she was discharged from the hospital to her previous nursing home. Discussion and conclusions Although therapeutic anticoagulation may sufficiently protect patients at cardiovascular risk, major complications such as bleeding complications may occur at any time. Therefore, physicians need to regularly re-evaluate any prior indication for therapeutic anticoagulation. With this case report, we hope to draw attention to the cohort of geriatric patients and the need for more and well differentiated study settings to preferably prevent any potentially avoidable complications.https://doi.org/10.1186/s12877-022-02781-6Geriatric medicineAnticoagulation complicationBleeding complicationHospitalistCase report |
| spellingShingle | Marcel Niemann Karl F. Braun Sufian S. Ahmad Christian Eder Ulrich Stöckle Frank Graef Therapeutic anticoagulation complications in the elderly: a case report BMC Geriatrics Geriatric medicine Anticoagulation complication Bleeding complication Hospitalist Case report |
| title | Therapeutic anticoagulation complications in the elderly: a case report |
| title_full | Therapeutic anticoagulation complications in the elderly: a case report |
| title_fullStr | Therapeutic anticoagulation complications in the elderly: a case report |
| title_full_unstemmed | Therapeutic anticoagulation complications in the elderly: a case report |
| title_short | Therapeutic anticoagulation complications in the elderly: a case report |
| title_sort | therapeutic anticoagulation complications in the elderly a case report |
| topic | Geriatric medicine Anticoagulation complication Bleeding complication Hospitalist Case report |
| url | https://doi.org/10.1186/s12877-022-02781-6 |
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