• Psychosomatics · Jul 2009

    Case Reports

    Bleeding the system: a case of feigned enoxaparin overdose.

    • Jason P Caplan.
    • St. Joseph's Hospital and Medical Center, 222 W. Thomas Rd., Suite 110A, Phoenix, AZ 85013, USA. jason.caplan@chw.edu
    • Psychosomatics. 2009 Jul 1; 50 (4): 413-5.

    BackgroundLow-molecular-weight heparins (LMWHs) have become ubiquitously used as anticoagulants because of their comparative safety and ease of use; however they may be fatal if taken in overdose, and lack of familiarity with their pharmacology may hinder appropriate care.ObjectiveThe author reports a case of feigned LMWH overdose so as to alert practitioners to this diagnostic possibility.MethodThis is a case report of a 49-year-old homeless man who reported a deliberate overdose of an injectable LMWH. The author reviews the mechanism of action and monitoring of LMWHs.ResultsOn the basis of his unusual presentation and previously documented history and medical work-up, he was ultimately diagnosed with malingering.DiscussionFeigned LMWH overdose is ideally suited to the purposes of malingering, since it represents a medical emergency that requires inpatient medical hospitalization and testing at outside laboratory facilities to verify the overdose.

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