Risk factors for the development of retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices.
OBJECTIVE
We sought to determine the incidence, clinical features, and risk factors for retroperitoneal hematoma (RPH) after percutaneous coronary intervention (PCI).


BACKGROUND
Little is known about the clinical features, outcomes, and determinants of this serious complication in the contemporary era of PCI.


METHODS
A retrospective analysis yielded 26 cases of RPH out of 3,508 consecutive patients undergoing PCI between January 2000 and January 2004. Cases were compared with a randomly selected sample of 50 control subjects without RPH.


RESULTS
The incidence of RPH was 0.74%. Features of RPH included abdominal pain (42%), groin pain (46%), back pain (23%), diaphoresis (58%), bradycardia (31%), and hypotension (92%). The mean systolic blood pressure nadir was 75 mm Hg. The hematocrit dropped by 11.5 +/- 5.1 points from baseline in RPH patients, as compared with 2.3 +/- 3.3 points in controls (p < 0.0001). The mean hospital stay was longer in RPH patients (2.9 +/- 3.8 days vs. 1.7 +/- 1.5 days, p = 0.06). The following variables were found to be independent predictors of RPH: female gender (odds ratio [OR] 5.4, p = 0.005), low body surface area (BSA <1.73 m(2); OR 7.1, p = 0.008), and higher femoral artery puncture (OR 5.3, p = 0.013). There was no association between RPH and arterial sheath size, use of glycoprotein IIb/IIIa inhibitors, or deployment of a vascular closure device.


CONCLUSIONS
Female gender, low BSA, and higher femoral artery puncture are significant risk factors for RPH. Awareness of the determinants and clinical features of RPH may aid in prevention, early recognition, and prompt treatment.
Farouque
H M Omar
HM
Division of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, USA.
Tremmel
Jennifer A
JA
Raissi Shabari
Farshad
F
Aggarwal
Meenakshi
M
Fearon
William F
WF
Ng
Martin K C
MK
Rezaee
Mehrdad
M
Yeung
Alan C
AC
Lee
David P
DP
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001830:Body Surface Area; D016022:Case-Control Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012187:Retroperitoneal Space; D012307:Risk Factors; D013536:Suture Techniques
D019039:Platelet Glycoprotein GPIIb-IIIa Complex