Spontaneous Hematoma of the Rectus Abdominis Muscle During Treatment with Non-vitamin K Oral Anticoagulant: A Rare Clinical Occurrence and Review of the Literature

Abstract

Vitamin k antagonist anticoagulants (VKAs) and non-vitamin K oral anticoagulants (NOACs) are widely used in the treatment of non-valvular atrial fibrillation and other indications, but both classes of medications carry a risk of potentially serious bleeding. Spontaneous hematoma of the rectus abdominis muscle is a rare complication of NOAC treatment. Several risk factors, such as trauma, surgery, anticoagulation, coughing, intense rectus muscle contractions, pregnancy, etc., have been reported to cause rectus sheath hematoma. We report a case of spontaneous hematoma of the rectus abdominis muscle associated with moderate hemoperitoneum in a patient treated with NOAC for non-valvular atrial fibrillation (AF).  Abdominal ultrasound and computed tomography scan (CT scan) confirmed the diagnosis after clinical assessment. The treatment was generally conservative but in the case of a hemodynamically unstable patient; hemostatic procedures should be considered.