Interesting case of expanding hematoma
Tue, 11/19/2019 - 6:18pm
77 y.o F PMHx CAD, AF on Eliquis presents with R thigh hematoma.
- Cardiac cath 10 days prior (access through R femoral)
- Also states fall few days prior, hitting R leg against book shelf
- Progressively worsening x6 days
BP 104/53 | Pulse 70 | Temp 97.9 °F | Resp 18 | SpO2 100%
- R thigh with large bruise extending from knee to hip, with extension to RLQ abdomen.
- Baseball sized area of swelling medial thigh with small bullae.
- Thigh and lower leg compartments soft.
- Motor/sensory intact.
- Palpable distal pulses.
- R femoral signal on doppler.
- Pseudoaneurysm (recent cath), expanding hematoma (recent trauma), active arterial bleed, acute blood loss anemia (in setting of AC)
- Labs: CBC, BMP, coags, type & screen
- Imaging: US groin pseu protocol, CTA RLE
RESULTS / MANAGEMENT
- HGB 6.4 from 9.6 five days prior
- US: Evolving R groin subcutaneous hematoma, 12.6 cm. No pseudoaneurysm or AV fistula.
- CTA: large hematoma with small active extravasation from inferior aspect of hematoma
- 1U pRBCs, Kcentra (later also given plasma)
- IR - successful coil embolization
TAKE HOME POINTS
- Cardiac cath complications - femoral artery pseudoaneurysm → may require surgical intervention
- Reversing NOACs (‘xabans’) - Eliquis, Xarelto
- Andexanet alfa (Andexxa): preferred reversal agent for patients with life threatening CNS, epidural, or ocular bleed or acute hemorrhage
- 4F PCC aka Kcentra: bleeding from other sites
- Contains Factors II, VII, IX, X, proteins C and S
- Second line: FFP
- Any concern for arterial bleeding or compromise requires CTA