The patient did not receive any blood products prior to the onset of hematuria, and the groin catheter insertion site did not reveal a hematoma. The patient was treated supportively with packed RBC, fresh frozen plasma, and cryoprecipitate for possible disseminated intravascular coagulation with significant hematuria. The heparin infusion was discontinued. Hematology studies performed 2 h after PMT revealed a prothrombin time of 14.8 (normal range, 9.1 to 11.5 s), partial thromboplastin time of 37 s (normal range, 24 to 35 s), a hemoglobin level of 10.6 g/dL, and platelet count of 136,000/μL. Schistocytes present on the peripheral blood smear and red supernatant on a centrifuged plasma sample consistent with free plasma hemoglobin suggested the development of fragmentation hemolysis secondary to mechanical thrombectomy. An atypical presentation of HELLP (hemolysis, elevated liver, low platelet) syndrome, an early consideration, was believed unlikely due to the time course and the minor platelet drop. Hematuria was attributed to hemoglobinuria, and the unfractionated heparin infusion was resumed. The hemolysis, resulting hemoglobinuria, and shock resolved within 24 h, allowing for extubation and transfer from the ICU. The remaining hospital course was uneventful, and the patient was discharged home on hospital day 7. An outpatient echocardiogram obtained shortly after discharge revealed normal biventricular function and pulmonary artery pressure.