Fatal Hematoma during Treatment with Adjusted-Dose Subcutaneous Heparin Therapy

Gabel, Andreas; Müller, Stefan

doi:10.1056/nejm199901073400115

Cited by 19 publications

(6 citation statements)

References 2 publications

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“…[16] RSH can be a relatively benign or life-threatening clinical condition depending on the size and location of the bleeding, the general health and the hemodynamic status of the patient. [17][18][19] It can also be confused with an intraabdominal inflammatory process that may lead to delayed diagnosis or unnecessary laparotomy before appropriate treatments begin. [20,21] RSH is frequently seen during the fifth and sixth decades.…”

Section: Discussionmentioning

confidence: 99%

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

İliklerden

Kalaycı

2021

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:Rectus sheath hematoma is a rare and frequently misdiagnosed cause of acute abdominal pain. In the management of the patients with rectus sheath hematoma, which are mostly with advanced age and comorbid diseases, positive results can be obtained by avoiding unnecessary surgical procedures with correct diagnosis and treatment approaches. The presented study aims to contribute to the lack of algorithms and optimal treatment strategies in the management of rectus sheath hematoma patients with the description of our experience in their management. METHODS:Patients who underwent treatment with the diagnosis of rectus sheath hematoma between May 2010 and July 2018 were retrospectively analyzed. Demographic characteristics, medical histories, physical and laboratory findings and imaging methods, treatment processes, complications, morbidity, mortality, length of hospitalization and long-term follow-up results were searched. Data were analyzed from patient files, hospital computer registry system and radiology archives. Data analysis was performed using Microsoft Excel and IBM-SPSS-Statistics-24. RESULTS:The mean age of the 31 patients was 63.03 years (24-85 years). The female/male ratio (21/10) was 2.1. The most common presenting sign or symptom was abdominal pain (100%), followed by abdominal wall mass in 25 patients (80.6%). Twenty-five patients (80.6%) were receiving some form of anticoagulation and antiplatelet therapy. Diagnosis was confirmed by Computed Tomography in 11 (45.4%), Ultrasonography in five (16.1%) and Computed Tomography with Ultrasonography in 15 (33.3%). Eight patients (25.8%) were evaluated as Type-1, 10 (32.2%) as Type-2 and 13 (41.9%) as Type-3. Mean International Normalized Ratio (INR) value of patients was 2.59. Bleeding was controlled by surgery in three cases (9.6%). The conservative approach was preferred in 28 cases (90.3%). 29 (93.5%) patients were discharged after an average hospital stay of 7.48 days (4-21). One patient died on the postoperative 5th day and other on the 14 th day of conservative treatment (6.45% mortality). The mortality rate of conservatively and surgically treated patients was 3.5% and 33.3%, respectively. CONCLUSION:Rectus sheath hematoma should be suspected in elderly patients using anticoagulants with acute abdominal pain, severe cough attacks and an umbilical palpable or radiologically supported mass. Computed Tomography and Ultrasonography should be performed in case of clinical suspicion. Early and correct diagnosis ensures successful conservative treatment and prevents unneces-sary surgical procedures. In the management of cases where clinician experience is at the forefront, we are hopeful that a new effective algorithm system and guidelines for the diagnosis will be identified after increasing the presentations of case series and experiences.

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Section: Discussionmentioning

confidence: 99%

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

İliklerden

Kalaycı

2021

Ulus Travma Acil Cerrahi Derg

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“…[34] Anticoagulation therapy has also been implicated as a risk factor for RSH. [56] It is unknown if coagulopathies caused by liver disease increase bleeding in RSH.…”

Section: Discussionmentioning

confidence: 99%

“…Fatality from RSH is uncommon, but has been reported in the literature. [589] The overall reported mortality rate in both surgical and conservatively managed patients is estimated to be 4% with increased mortality in patients on anticoagulation and those requiring surgical intervention. [8]…”

Section: Discussionmentioning

confidence: 99%

Fatal spontaneous rectus sheath hematoma in a patient with cirrhosis

McCarthy

Bellam

2010

J Emerg Trauma Shock

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“…Retroperitoneale Hämatome können als Komplikation unter antikoagulativer Therapie auftreten. Während die Inzidenz von hämorrhagischen Komplikationen unter antikoagulativer Therapie zwischen 0,25 bis 23 % beträgt [15,32], wird die Inzidenz von retroperitonealen Hämatomen unter antikoagulativer Therapie mit 6,6 % bei Patienten unter Heparintherapie wegen venöser Thrombose angegeben [33]. Eine Durchsicht der Literatur zeigt, dass bislang nur wenig über das Management von retroperitonealen Hämatomen publiziert wurde.…”

Section: Diskussionunclassified