Clinical, Laboratory, and Imaging Characteristics of Spontaneous Soft-Tissue Hematomas in Anticoagulated Patients: Arterial Embolization Versus Conservative Treatment.

PURPOSE: To compare outcomes (clinical, laboratory and imaging features) and identify predictive factors for arterial embolization versus conservative treatment in the management of anticoagulated patients with spontaneous abdominal or pelvic hematomas.

MATERIAL AND

METHODS

This retrospective single-center study analyzed 219 patients under anticoagulation therapy with spontaneous soft-tissue hematoma, between 2015 and 2020. Sixty two patients (28%) were treated with transcatheter arterial embolization (TAE) after multidisciplinary team discussion. Demographics, clinical, laboratory data, computed tomography (CT) findings, and treatment details were compared. Clinical success was defined as cessation of bleeding, hemodynamic stabilization, and hemoglobin level stabilization. Prognostic factors for 30-day mortality were assessed using univariate and multivariate Cox analyses.

RESULTS

Patients referred for embolization presented more frequently with hemodynamic instability (41.7% vs. 10.2%, p < 0.001), larger hematomas (1024 cm3 vs. 488 cm3, p < 0.001), and more frequent contrast extravasation in the arterial phase (85.4% vs. 51.0%, p < 0.001) and fascial rupture (45.2% vs. 12.7%, p < 0.001) on CT. Conservative management was more common in patients with anticoagulant overdose (51.1% vs. 25.5%, p = 0.002), especially vitamin K antagonists (50.4% vs. 33.0%, p = 0.024). Technical success of TAE was 93.5%, and primary clinical success was 75%. The 30-day all-cause mortality rate following embolization was 22.6%. Univariate analysis identified impaired renal function (p < 0.001), large hematoma volume (p = 0.038), and fascial rupture (p = 0.037) as predictors of mortality. No independent variable remained significant in multivariate analysis.

CONCLUSION

TAE is an effective treatment option in selected patients with severe anticoagulant-related muscle hematomas, particularly in cases of hemodynamic instability or CT evidence of active bleeding and fascial rupture.