Soft tissue bleeding associated with antithrombotic treatment: technical and clinical outcomes after transcatheter embolization

Abstract

Purpose: To assess retrospectively technical and clinical outcomes after transcatheter embolization in patients presenting with soft tissue bleeding associated with antithrombotic therapy and to determine factors potentially affecting the clinical outcomes after embolization.

Materials and methods: There were 42 patients who underwent embolization for soft tissue bleeding associated with antithrombotic therapy. Principal clinical symptoms were hemodynamic shock (n = 21), abdominal pain (n = 9), back pain (n = 7), and buttock or thigh pain (n = 5). Ultrasound or computed tomography (CT) or both were performed in 40 patients (95%); 2 patients (5%) were immediately referred for angiography. Several laboratory and radiographic factors were analyzed to determine if any influenced the clinical outcome.

Results: A hematoma was identified in the anterior abdominal wall (n = 18 [43%]), in the retroperitoneum (n = 18 [43%]), or in the thigh or gluteal region (n = 6 [14%]). Embolization was successful in all patients; early recurrent bleeding with a fatal outcome was recorded in one patient (2%). In nine patients (22%), secondary surgical drainage of the hematoma was performed to manage a compartment syndrome. During follow-up (mean, 37.9 months; range, 0.03-85.28 months), 11 patients (26%) died; death was related to the bleeding in 6 patients (14%). Both activated partial thromboplastin time (aPTT) and prothrombin time (PT) were correlated with hematoma size. Prolonged aPTT before embolization was associated with a higher risk of bleeding-related mortality (P = .04).

Conclusions: Transcatheter embolization was very effective in stopping soft tissue bleeding associated with antithrombotic therapy. However, there was still considerable morbidity and mortality after successful embolization. aPTT prolongation emerged as a risk factor for bleeding-related deaths.