Spontaneous iliopsoas hematoma in patients with unstable coronary syndromes receiving intravenous heparin in therapeutic doses

Abstract

Objective: To identify the relationship between the use of anticoagulants, specifically heparin, and the development of iliacus and psoas muscle hematoma. Three patients with unstable angina who developed groin pain while on heparin anticoagulation are presented. Patients who are anticoagulated with heparin are at increased risk of developing iliacus or psoas hematoma, manifesting a wide range of symptoms from groin pain to massive bleeding and shock. Identification of these patients is crucial in cardiology practice.

Data sources: MEDLINE searches under "iliacus', "psoas' and "iliopsoas hematoma' were conducted and cross-referenced with patients on anticoagulant therapy. Only English language articles were included.

Study selection: The search covered January 1966 to February 1995. Fifty-one articles were studied.

Data synthesis: The current literature suggests that anticoagulation can cause iliacus or psoas muscle hematoma and usually presents as femoral neuropathy. However, the presented case reports provide evidence that an earlier manifestation of this entity is the development of groin pain, and that early identification is crucial to improving patient morbidity and mortality.

Conclusions: Patients who are on heparin anticoagulation should be carefully monitored for development of groin pain or leg weakness. In such cases, early recognition of possible iliacus or psoas hematoma should be by abdominal ultrasound or computed tomography, and heparin anticoagulation should be modified according to its clinical requirement.