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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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