Muscle haematoma due to antithrombotic treatment for ischaemic stroke

Hiraga, Akiyuki; Nakagawa, Yoko; Kamitsukasa, Ikuo; Suzuki, Takeshi; Kuwabara, Satoshi

doi:10.1016/j.jocn.2015.01.023

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…Major muscular hematomas have been very rarely associated with antiplatelet agents, 8.8% in the present study and 4% in our previous study [6], irrespective of location. Indeed, only case-reports of patients with major muscular hematoma associated with antiplatelet agents were found [16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort

Bouget¹,

Huet²,

Roy³

et al. 2021

Thrombosis Research

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Background: There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants.Objective: To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality.Patients and Methods: Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated. Clinical and biological data, therapeutic management of the bleeding event, and in-hospital mortality were collected from the medical records and compared across five groups of hematoma locations.Potential confounders were taken in account using a multivariate binomial regression model.Results: Three hundred and seventy-five patients were included (mean age = 81.4 years): 271 were exposed to vitamin K antagonists, 58 to parenteral anticoagulants (heparin, LMWH, fondaparinux), 33 to antiplatelets, and 13 to direct oral anticoagulants. The muscular hematomas were located in the lower limbs (n = 198), the rectus sheath (n = 71), the iliopsoas (n = 45), the upper limbs (n = 33), or elsewhere (n = 28). Reversal therapy was prescribed for 48.5% of patients, red cell transfusions for 63.6%, surgery for 12.3% and embolization for 3.5%. For 84% of patients, hospitalization was required, with a median length of stay of 10 days. Overall, in-hospital mortality was 8.5%. Reversal therapy, the need for intensive care and mortality were significantly more frequent among patients with iliopsoas hematomas. The independent predictors of in-hospital mortality were: decrease in mean arterial pressure (RR = 1.84), decrease in hemoglobin level (RR = 1.37) and the iliopsoas location (RR = 3.06). Conclusion:Frail elderly patients with major muscular hematomas linked to antithrombotic agents risk substantial morbidity and in-hospital mortality. The iliopsoas location was the most life-threatening bleeding site. Close observation of this population is warranted to ensure better outcomes.

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Section: Discussionmentioning

confidence: 99%

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort

Bouget¹,

Huet²,

Roy³

et al. 2021

Thrombosis Research

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“…3 Iliopsoas hematoma is a rare but serious bleeding event that occurs in patients with hemophilia, those who have undergone trauma, and those who are receiving anticoagulation therapy. [4][5][6][7] The incidence and mortality of iliopsoas hematoma as a complication of anticoagulant therapy are 0.6-6.6% and 20%, respectively. 7,8 In terms of complications of tetanus, there has been one report of a case of rectus abdominis sheath hematoma 9 ; however, no cases of iliopsoas hematoma have been reported to date.…”

Section: Introductionmentioning

confidence: 99%

“…Iliopsoas hematoma is a rare but serious bleeding event that occurs in patients with hemophilia, those who have undergone trauma, and those who are receiving anticoagulation therapy . The incidence and mortality of iliopsoas hematoma as a complication of anticoagulant therapy are 0.6–6.6% and 20%, respectively .…”

Section: Introductionmentioning

confidence: 99%

Iliopsoas hematoma as a complication of tetanus

Ishii

Mochizuki

Shiomi

et al. 2018

Neurology & Clinical Neurosc

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Background: Iliopsoas hematoma is a rare but serious bleeding event that occurs during anticoagulation therapy. Due to lack of previous reports of clinical data, incidence and characteristics of iliopsoas hematoma during tetanus management, including anticoagulation prophylaxis for venous thromboembolism, remain unclear. Aim: To evaluate the incidence of iliopsoas hematoma in tetanus and identify clinical factors that would help in its detection. Materials and Methods: We conducted a retrospective descriptive study and evaluated the clinical courses of patients with iliopsoas hematoma as a case series. Patient data were collected by reviewing medical charts. Results: Among 21 patients, four (19%) developed iliopsoas hematoma during the clinical course of tetanus. A case series of these four patients revealed that all had progressive anemia; furthermore, D-dimer levels continued increasing or did not decrease in these patients despite them receiving anticoagulation therapy. Conclusion: The incidence of tetanus-related iliopsoas hematoma was higher than that of anticoagulation-related iliopsoas hematoma. Therefore, clinicians should carefully consider the indication of prophylaxis for venous thromboembolism in patients with tetanus. Progressive anemia and increased D-dimer level may indicate iliopsoas hematoma in patients with tetanus.

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“…(USG) and computed tomography (CT) in the evaluation of acute abdominal pain decreased the failure rate of diagnosing RSH to ≤ 30% [3,4]. This gave the chance for conservative management, considered nowadays to be the key treatment of RSH, to take place more frequently [5]. However, we still find in the literature that surgical intervention is recommended for RSH > 5cm in diameter [3].…”

Section: Introductionmentioning

confidence: 99%

Conservative management of a progressively growing rectus sheath hematoma presented in a patient with chronic renal failure: A case report

Bekraki¹,

Hanna²,

Abs³

2016

MMJ

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Introduction: Rectus sheath hematoma is a rare but an important clinical entity in the differential diagnosis of abdominal pain. It is often a self-limiting condition that can be managed successfully in conservative measures. If not recognized, it can lead to unnecessary emergency surgical procedures. A 55-year-old male patient suffering from chronic renal failure and cardiomyopathy presented with a progressively growing abdominal mass diagnosed to be a bilateral rectus sheath hematoma. Despite many complications related to alteration of general status, electrolyte imbalance and coagulation problems, conservative management proved successful, while prompt surgical intervention could have ended in death in such a fragile patient.

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Muscle haematoma due to antithrombotic treatment for ischaemic stroke

Cited by 6 publications

References 20 publications

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort

Iliopsoas hematoma as a complication of tetanus

Conservative management of a progressively growing rectus sheath hematoma presented in a patient with chronic renal failure: A case report

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