Warfarin-Related Iliopsoas Hematoma with Femoral Neuropathy After Transcatheter Aortic Valve Replacement : a case report

Background: Iliopsoas/iliacus hematoma is an uncommon but potentially limb-threatening complication of anticoagulation. When it occurs in the early post–transcatheter aortic valve replacement (TAVR) period, it may be misattributed to access-site pain or musculoskeletal causes, delaying diagnosis. We report a warfarin-associated iliopsoas hematoma complicated by femoral neuropathy after transfemoral TAVR. Case presentation: A 77-year-old woman underwent transfemoral TAVR and was started on warfarin for postoperative anticoagulation. She developed acute hip/groin pain followed by progressive anterior-thigh numbness and lower-limb weakness. Laboratory testing showed a markedly supratherapeutic international normalized ratio (INR) of 8.04. Computed tomography revealed a left iliopsoas/iliacus hematoma with mass effect on the femoral nerve; computed tomography angiography excluded major arterial injury or active extravasation. Warfarin was discontinued and anticoagulation was reversed with vitamin K; supportive management, including analgesia and mecobalamin, was provided. Symptoms improved over the following week with INR normalization, and neurological function continued to recover on follow-up. Conclusions: In anticoagulated post-TAVR patients presenting with new hip/groin pain and/or femoral neuropathic signs, prompt cross-sectional imaging should be considered to exclude retroperitoneal or iliopsoas hematoma. Early recognition and timely anticoagulation reversal are critical to optimize neurological outcomes.