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Bleeding the System: A Case of Feigned Enoxaparin Overdose

Received February 13, 2008; revised March 10, 2008; accepted March 11, 2008. From the Department of Psychiatry, Creighton University, Omaha, NE. Send correspondence and reprint requests to Jason P. Caplan, M.D., St. Joseph’s Hospital and Medical Center, 222 W. Thomas Rd., Suite 110A, Phoenix, AZ 85013. e-mail: jason.caplan{at}chw.edu
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Low-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. OBJECTIVE: The author reports a case of feigned LMWH overdose so as to alert practitioners to this diagnostic possibility. METHOD: This 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. RESULTS: On the basis of his unusual presentation and previously documented history and medical work-up, he was ultimately diagnosed with malingering. DISCUSSION: Feigned 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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