title: Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization.
abstract: OBJECTIVE
  The purpose of this study was to report the effectiveness and safety of selective arterial embolization for the management of anticoagulation-related soft-tissue bleeding.
  
  
  METHODS
  All consecutive patients from June 1, 2003, to June 1, 2010, with intractable anticoagulation-related soft-tissue bleeding treated by embolization were included. The clinical files, MDCT angiographic examinations, and procedure details were reviewed. The primary goal of this study was to report the safety and efficacy of embolization for the management of anticoagulation-related soft-tissue bleeding. The secondary goal was to evaluate the correlation between the MDCT angiography (MDCTA) findings and conventional catheter angiography.
  
  
  RESULTS
  Thirty-six consecutive patients were included. All patients were under anticoagulant therapy. Overdosage of the anticoagulant was found in 12 (33%) patients. MDCT was performed with multiphasic contrast media injection in 30 patients (83%) and showed extravasation in 22 (73.3%) of those 30 patients. Catheter angiography revealed extravasation in 27 of 36 (75%) patients, and no active bleeding was observed in nine patients who were empirically embolized. The sensitivity of MDCTA for depicting ongoing active bleeding was 87%. The transfusion requirement for RBC units decreased from 4.0 (range, 0-12.0) before to 0 (range, 0-4.0) after embolization. Nine patients underwent a second embolization but only one in the same vascular territory. Eleven patients died within 30 days despite the embolization. No complications related to embolization were reported.
  
  
  CONCLUSIONS
  Anticoagulation-related soft-tissue bleeding can be efficiently and safely treated by selective arterial embolization. However, this serious pathologic condition may be fatal in many cases, and rebleeding is not rare. MDCTA could help to guide treatment.
authors.affiliation: 1 Department of Body and Interventional Imaging, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 20 rue Leblanc, 75908 Paris Cedex 15, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dohan
authors.forename: Marc
authors.initials: M
authors.lastname: Sapoval
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Chousterman
authors.forename: Massimiliano
authors.initials: M
authors.lastname: di Primio
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guerot
authors.forename: Olivier
authors.initials: O
authors.lastname: Pellerin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D000925:Anticoagulants / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy*; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D009135:Muscular Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006490:Hemostatics
keywords: abdominal wall hemorrhage; anticoagulant therapy; arterial embolization; psoas hemorrhage; soft-tissue bleeding