Balbay, ÖnerTüzüner, TolgaArbak, PeriOrhan, ZaferErbaş, MeteAydogßan, Ieker2021-06-232021-06-2320041424-7860https://hdl.handle.net/20.500.12491/4516https://www.scopus.com/inward/record.uri?eid=2-s2.0-1442327160&partnerID=40&md5=b9b363d05f99a04f8075050cf2667022Fixed-dose, subcutaneous Low Molecular Weight Heparin (LMWH) is as effective and safe as adjusted-dose, intravenous unfractionated heparin (UFH) for the initial management of venous thromboembolism and symptomatic pulmonary thromboembolism [1–4]. Clinical experiences indicate that bleeding is a major side effect, not only of UFH, but also of LMWH [5]. An 81-year-old woman (60 kg) was admitted with a clinically suspected pulmonary embolism (SPE) with a 2-day history of pleuritic chest pain and dyspnoea. Her past medical history showed congestive heart failure, atrial fibrillation (AF) and hyperthyroidism, immobilisation due to femoral head fracture 7 years previously. Propylthiouracilcoumadin, aspirin, perindopril, spironolactone, and digoxin were started in May 2000 and propylthiouracil and coumadin was discontinued after 3 months follow-up. Owing both to SPE and chronic AF she was started on nadroparin subcutaneously twice daily 5700 UI AXa/ 0.6 ml. The ventilation/perfusion scan of the lung was reported as having low probability of pulmonary embolism and a duplex ultrasound of the lower limbs was negative for DVT the night after the symptoms started. Despite these findings anticoagulant treatment was continued due to the chronic AF. Except for slightly raised white blood cells and a raised creatinine on admission her laboratory results and coagulation parameters were within normal limits. Two days after anticoagulant treatment, she complained of sudden onset of left leg pain with the finding of a tender haematoma (measuring 51025 cm). There was no history of trauma. Together with nadroparin aspirin was also discontinued.eninfo:eu-repo/semantics/closedAccessSpontaneousHaematomaThromboembolismLetter1347-8110111151060282-s2.0-1442327160Q2