Treatment-resistant priapism associated with long-term low-molecular-weight heparin.

David Bouchier-Hayes, Philip Nolan, Gordon Pate

BMJ case reports 2021 Apr 01

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This case report summarises the case of a 56-year-old man with low-flow, ischaemic priapism requiring urgent insertion of a penile prosthesis following prophylactic anticoagulation with tinzaparin. Low-molecular-weight heparin (LMWH) has been proposed as a cause of ischaemic priapism, although reported cases of this are rare. This particular side effect of tinzaparin has been reported once in a case report in 2018, and there are scant other reports of LMWH-induced priapism. This case was refractory to the full treatment algorithm, including multiple aspirations, phenylephrine injection, cavernosal shunt and required transfer for implantation of a penile prosthesis. Only one other case of such a severe case of priapism has been documented, involving LMWH and warfarin. Documented evidence of possible causes of priapism are vital, given the rarity of this condition, the frequency of LMWH and the potentially devastating complications. © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

David Bouchier-Hayes, Philip Nolan, Gordon Pate. Treatment-resistant priapism associated with long-term low-molecular-weight heparin. BMJ case reports. 2021 Apr 01;14(4)