{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:01:49Z","timestamp":1789794109697,"version":"4.0.1"},"reference-count":5,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>An anticoagulated patient with unilateral thigh swelling may have more than one process. A 79-year-old man receiving long-term warfarin for atrial fibrillation and a previous ischemic stroke presented with 3 days of atraumatic left-thigh pain, swelling, and inability to walk. His international normalized ratio was 6.41. Computed tomography (CT) showed an approximately 4 cm \u00d7 7 cm intramuscular hematoma in the left vastus intermedius. Duplex ultrasonography additionally demonstrated femoropopliteal venous thrombosis causing partial occlusion, with absent spectral flow in the sampled femoral vein segment and residual popliteal venous flow. Warfarin was initially withheld without reversal therapy. CT-guided drainage was performed after the international normalized ratio decreased to 1.44, and follow-up CT angiography showed no active bleeding. Edoxaban 60 mg once daily was started 8 days after drainage. Following rehabilitation, the patient was discharged in stable condition and was able to walk independently. These images illustrate that hemorrhage and venous thrombosis can coexist despite supratherapeutic anticoagulation; CT and duplex ultrasonography provide complementary information that can prevent diagnostic anchoring and guide the sequence of source control and anticoagulation resumption.<\/jats:p>","DOI":"10.3390\/diagnostics16183002","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:50:27Z","timestamp":1789566627000},"page":"3002","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent Intramuscular Thigh Hematoma and Femoropopliteal Venous Thrombosis During Supratherapeutic Warfarin Anticoagulation"],"prefix":"10.3390","volume":"16","author":[{"given":"Hung-Ming","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6370-7068","authenticated-orcid":false,"given":"Tse-Hao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.thromres.2020.12.022","article-title":"Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort","volume":"199","author":"Bouget","year":"2021","journal-title":"Thromb. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s00270-026-04370-1","article-title":"Clinical, laboratory, and imaging characteristics of spontaneous soft-tissue hematomas in anticoagulated patients: Arterial embolization versus conservative treatment","volume":"49","author":"Moyne","year":"2026","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1055\/a-2173-7729","article-title":"Recurrent venous thromboembolism in patients on anticoagulation: An update based on the revised AWMF S2k guideline","volume":"44","author":"Klamroth","year":"2024","journal-title":"H\u00e4mostaseologie"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.jacc.2020.04.053","article-title":"2020 ACC Expert Consensus Decision Pathway on management of bleeding in patients on oral anticoagulants","volume":"76","author":"Tomaselli","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","article-title":"Edoxaban versus warfarin in patients with atrial fibrillation","volume":"369","author":"Giugliano","year":"2013","journal-title":"N. Engl. J. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3002\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T04:14:15Z","timestamp":1789791255000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":5,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16183002"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16183002","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}