Treatment of bleeding from endogenous heparin-like substances after traumatic injury with protamine: a case report

Abstract

Abstract Background To provide reference for clinical treatment of trauma-induced coagulopathy. Persistent bleeding caused by endogenous heparin-like substances is difficult to identify and diagnose. This report describes the clinical manifestations and management of patients with continuous non-surgical bleeding after trauma. It not only provides the importance of thromboelastography in assisting diagnosis, but also summarizes the effective therapeutic drugs, and provides reference for clinical treatment of trauma-induced coagulopathy. Case presentation A 31-year-old previously healthy Chinese male was referred to our department with continuous non-surgical bleeding after trauma. The patient received significant amounts of red cells, platelets, plasma and cryoprecipitate. Tranexamic acid and fibrinogen were used to prevent fibrinolysis. Then the patient underwent an interventional left iliac artery embolization in the early morning of the next day due to the inability to stop the bleeding. But the abnormal bleeding symptoms in the left thigh could not be corrected. Coagulation disturbances in this patient were confirmed by monitoring TEG to be caused by increased endogenous heparin-like substances. This bleeding disorder was quickly corrected by protamine, neutralizing the heparin-like substances. Conclusions TEG monitoring should be repeated in cases of unexplained coagulopathy when other coagulopathies and exogenous medication are excluded. Protamine is an effective treatment for endogenous heparinization.