We report the case of a patient with
pulmonary embolism, treated with
fondaparinux as bridging
therapy until therapeutic levels were achieved on
warfarin, who developed a non-traumatic massive retroperitoneal haematoma requiring substantial
resuscitation with blood products and arterial embolisation. To our knowledge, this condition has not been reported with therapeutic doses of
fondaparinux. Our patient, however, may have been more predisposed to
bleeding due to the unpredictable pharmacokinetics of
fondaparinux secondary to his
morbid obesity, reduced clearance of the
drug due to
renal insufficiency and concomitant treatment with low dose
aspirin and
warfarin. Another consideration was the lack of a specific reversing agent for
fondaparinux in the setting of a life threatening haemorrhage.