An ultrasound at Tam Anh General Hospital, Ho Chi Minh City, revealed a hemorrhage within the patient's abdominal wall muscle. A hematoma, approximately 50x35 mm—the size of a chicken egg—had formed at the site.

Ms. Lien underwent mechanical aortic valve replacement and tricuspid valve repair 24 years ago. Due to chronic atrial fibrillation, she takes anticoagulants to prevent blood clots. She consistently attended regular check-ups and followed her doctor's medication instructions.

Upon admission, Ms. Lien's INR (international normalized ratio), a measure of blood clotting for those on anticoagulants, was 2,1. Doctor Do Anh Tuan, from Cardiology Department 1 at the Heart Center, explained that the target INR for patients with mechanical heart valves is typically 2,5-3,5. An INR of 2,1 suggested her blood was not excessively thin, indicating a low risk of spontaneous bleeding. Therefore, it was probable that Ms. Lien's prolonged coughing led to continuous, strong contractions of her abdominal wall muscles, rupturing small blood vessels and causing internal bleeding.

Doctors initiated treatment to alleviate the patient's cough and closely monitored her condition with repeated ultrasounds to track the hematoma's size. Given that her INR remained within the therapeutic range, the anticoagulant medication was continued to mitigate the risk of heart valve thrombosis or stroke.

Two days later, her coughing symptoms significantly subsided, and the hematoma's size remained unchanged, indicating stable bleeding. A few days after that, Ms. Lien's abdominal pain resolved, her INR stabilized at 2,5, and she was discharged. Doctors explained that the hematoma would gradually reabsorb over time.

Doctor Tuan checking on the patient before discharge. *Photo: Ha Vu*

Anticoagulants, commonly known as "blood thinners," prevent blood clot formation in patients with conditions such as atrial fibrillation, mechanical heart valve replacements, valvular heart disease, and venous thrombosis.

Master, Doctor Huynh Thanh Kieu, Head of Cardiology Department 1 at the Heart Center, Tam Anh General Hospital, Ho Chi Minh City, highlighted that the most common side effect of anticoagulants is an increased risk of bleeding. Consequently, patients must adhere to the prescribed dosage, avoid self-adjusting or discontinuing the medication, and undergo regular INR tests as directed to ensure appropriate dosage.

Doctors advise patients on anticoagulants to minimize impacts, exercise caution with sharp objects, prevent falls, and avoid self-administering intramuscular injections or acupuncture. Should symptoms like unusual bruising, prolonged nosebleeds, red urine, black stools, or severe, unexplained abdominal pain occur, immediate medical attention at a hospital is crucial.

Thu Ha

*Patient's name has been changed