Role of percutaneous transcatheter embolization (PTE) in the treatment of spontaneous bleeding associated with anticoagulant therapy

Radiol Med. 2015 Jan;120(1):149-57. doi: 10.1007/s11547-014-0470-4. Epub 2014 Nov 12.

Abstract

Purpose: To evaluate safety and clinical efficacy of percutaneous transcatheter embolization (PTE) in the treatment of spontaneous bleedings (SBs) in patients submitted to chronic anticoagulation therapy.

Materials and methods: From January 2007 to December 2012, 20 patients (mean age 75.8 years, range 68-91 years) with 23 SBs were retrospectively evaluated. Active bleeding was documented by contrast enhanced-multidetector row computed tomography (CE-MDCT). PTE was performed using different embolic agents. Technical success (TS), clinical success (CS), late success (LS) and mortality rate (M) related to the angiographic procedure and complications were evaluated.

Results: CE-MDCT and digital subtraction angiography (DSA) identified active bleeding sites in 18 cases (18/20). In two cases (2/20) DSA did not confirm the arterial bleeding diagnosed on CE-MDCT. Twenty-three sessions of PTE were performed. TS, CS, LS and M were, respectively, 100, 85, 15 and 0%. No major complications were observed.

Conclusions: PTE could be considered a safe and effective "first line" approach to treat SB associated with anticoagulation therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Anticoagulants / adverse effects*
  • Contrast Media
  • Embolization, Therapeutic / methods*
  • Enoxaparin / adverse effects
  • Female
  • Hemorrhage / chemically induced*
  • Hemorrhage / therapy*
  • Humans
  • Male
  • Retrospective Studies
  • Treatment Outcome
  • Warfarin / adverse effects

Substances

  • Anticoagulants
  • Contrast Media
  • Enoxaparin
  • Warfarin