Delayed subdural hematoma after receiving enoxaparin for prevention of thromboembolic events from high-risk surgery.

Enoxaparin (Lovenox) is a low–molecular weight heparin used to prevent deep venous thrombosis in patients undergoing total hip or knee arthroplasty. Anticoagulation in a patient after trauma may be dangerous and lead to significant hemorrhage. An elderly man fell and sustained a concussion and a hip fracture. His initial computed tomographic scan of the head was normal. He received enoxaparin perioperatively and developed a delayed extensive subdural hematoma. Although enoxaparin has been shown to be an effective and a safe drug for venous thromboembolism prophylaxis in orthopedic surgeries and trauma, severe bleeding may rarely occur, especially in the setting of head trauma. Other therapies for venous thromboembolic prophylaxis, such as mechanical thromboembolism prophylaxis methods, should be considered.