Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin

Figure 1

Anti-Xa levels of the patient throughout his hospital admission. LMWH doses are not included as they varied from day to day following the patient’s lab results. For reference, the regimen used after September 7 was as follows: <0.35 units/mL: increased dose by 25%, repeat anti-Xa 4 hours after next dose. 0.35–0.49 units/mL: increased dose by 10%, repeat anti-Xa 4 hours after next dose. 0.5–0.59 units/mL: keep same dose, repeat anti-Xa next day. 0.6–1.0 units/mL: contact on call fellow for further recommendations. 1.0–1.5 units/mL: decrease dose by 20%, repeat level before next dose. 1.6–2 units/mL: hold dose for 3 h, then decrease dose by 30%. Repeat level before next dose, then 4 h after next dose. >2 units/mL: hold all doses until anti-Xa is 0.5 units/mL, then decrease dose by 40%. Repeat level before next dose, then q12h until anti-Xa is <0.5 units/mL.