PMC5818886_01
(a) Timeline of heparin clearance with protamine administration. Left y-axis: aPTT; right y-axis: anti-Xa. Arrows demarcate timing and dose of protamine administration. aPTT: activated partial thromboplastin time; reference range 27-38 seconds. Anti-Xa: antifactor Xa activity; reference 0 or <0.3 IU/mL for prophylactic dosing; reference range 0.3-0.7 for therapeutic anticoagulation. (b) Clinical timeline. Activated partial thromboplastin time and thrombin time measured in seconds. Anti-Xa measured in IU/mL. (c) Representative axial images from the patient's chest CT demonstrating multifocal soft tissue hematomas (arrows).
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fig1
Computed tomography (CT) of the chest revealed an expansive subcutaneous hematoma involving the posterior chest wall and right supraclavicular region (Figure 1). The aPTT normalized to 35.3 s the following day with no additional doses (Figure 1). Of note, despite the administration of protamine, the heparin clearance was remarkably delayed (Figure 1).