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Images in cardiovascular medicine
Empirical embolisation for intermittent spontaneous muscle haemorrhage associated with anticoagulation therapy
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  1. Kenichiro Sawada,
  2. Osami Kawarada,
  3. Satoshi Yasuda
  1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  1. Correspondence to Dr Osami Kawarada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka 565-8565 Japan; kawarada90{at}hotmail.com

https://doi.org/10.1136/heartasia-2017-010967

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    As more patients are receiving anticoagulant therapy, spontaneous muscle haemorrhage (SMH) has become a common, potentially life-threatening complication.1 2 However, no standardised approach for SMH has established and intermittent SMH is challenging to manage because of lack of reports.

    A 77-year-old man with a history of double mechanical heart valve replacement and chronic atrial fibrillation on warfarin complained of sudden onset of painful swelling in the left leg. Contrast-enhanced computed tomography (CT) revealed femoral and crural muscle haemorrhage (figure 1A) despite a moderate intensity of anticoagulation (Prothrombin time-international normalised ratio 2.01). Following blood transfusion for progressive anaemia, urgent angiography including selective angiography demonstrated no evidence of active bleeding. …

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