Acute compartment syndrome of the thigh is a rare surgical emergency. It is usually associated with high energy trauma and concomitant femoral fracture. We present the case of a 54 year old man who developed acute compartment syndrome of the thigh following a low energy traumatic hamstring tear. Background anti-platelet therapy and hospital prescribed anticoagulants were likely contributors to this pathology. We describe these factors and discuss the issues associated with assessment of minor trauma in the anti-coagulated patient.