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Anticoagulant related abdominal hematomas: Clinical and CT findings

Yıl 2018, Cilt: 17 Sayı: 2, 50 - 61, 24.09.2018
https://doi.org/10.17941/agd.425110

Öz

Background
and Aims:
We aimed to evaluate the clinical features and
computed tomography(CT) findings of anticoagulant-related abdominal hematomas.

Material and methods: This was a
systematic retrospective study of 55 patients (mean age: 66±12 years, range
29-84 years) on anticoagulant therapy who were diagnosed with abdominal
hematoma between March 2008 and May 2016.The patients were evaluated for
demographic characteristics, clinical manifestations, medical history,
associated factors, biochemical tests, CT findings, treatment and outcomes.

Results:
Warfarin was the most commonly used anticoagulant agent (72.7%), followed by
enoxaparin (20%), and both warfarin and enoxaparin (7.3%). The main clinical
symptoms were abdominal pain and abdominal distention. In total of 85 hematoma
location, the most frequent locations were the rectus muscle sheath (50.9%) and
gastrointestinal tract (30.9%). Fifteen (27.3%) patients had major hemorrhage
by using criteria of the Control Anticoagulation Comittee.











Conclusion: The knowledge of the most common clinical and
CT findings of anticoagulant-related abdominal hematomas allows prompt and
accurate diagnosis and has also direct impact on clinical management.
    

Kaynakça

  • 1. S. D. O'Connor, A. J. Taylor, E. C. Williams, et al. Coagulation concepts update. AJR Am J Roentgenol. 2009;193(6):1656-64.2. M. Tonolini, S. Ippolito, F. Patella, et al. Hemorrhagic complications of anticoagulant therapy: role of multidetector computed tomography and spectrum of imaging findings from head to toe. Curr Probl Diagn Radiol. 2012;41(6):233-47.3. M. N. Levine, G. Raskob, S. Landefeld, et al. Hemorrhagic Complications of Anticoagulant Treatment. Chest. 2001;119(1):108S-21S.4. C. S. Landefeldand R. J. Beyth. Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med. 1993;95(3):315-28.5. L. N. Nazarian, A. S. Lev-Toaff, C. M. Spettell, et al. CT assessment of abdominal hemorrhage in coagulopathic patients: impact on clinical management. Abdominal Imaging. 1999;24:246-9.6. M. Fortina, S. Carta, E. O. Del Vecchio, et al. Retroperitoneal hematoma due to spontaneous lumbar artery rupture during fondaparinux treatment. Case report and review of the literature. Acta Biomed. 2007;78(1):46-50.7. I. Kocayigit, Y. Can, S. Sahinkus, et al. Spontaneous rectus sheath hematoma during rivaroxaban therapy. Indian J Pharmacol. 2014;46(3):339-40.8. S. Schulman, R. J. Beyth, C. Kearon, et al. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):257S-98S.9. V. M. Alla, S. M. Karnam, M. Kaushik, et al. Spontaneous rectus sheath hematoma. West J Emerg Med. 2010;11(1):76-9.10. A. Guven, G. Sokmen, E. Bulbuloglu, et al. Spontaneous abdominal hematoma in a patient treated with clopidogrel therapy: a case report. Ital Heart J. 2004;5(10):774-6.11. S. Schulman, C. Kearon, S. Subcommittee on Control of Anticoagulation of the, et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692-4.12. J. Ansell, J. Hirsh, J. Dalen, et al. Managing oral anticoagulant therapy. Chest. 2001;119(1 Suppl):22S-38S.13. J. H. Tapia-Perez, S. Gehring, R. Zilke, et al. Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg. 2014;118:37-43.14. M. Jun, M. T. James, B. J. Manns, et al. The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. BMJ. 2015;350:h246.15. S. J. Swensen, R. A. McLeodand D. H. Stephens. CT of extracranial hemorrhage and hematomas. AJR Am J Roentgenol. 1984;143(4):907-12.16. E. Gokce, M. Beyhanand B. Acu. Evaluation of Oral Anticoagulant-Associated Intracranial Parenchymal Hematomas Using CT Findings. Clin Neuroradiol. 2015;25(2):151-9.17. R. Zissin, M. Ellisand G. Gayer. The CT findings of abdominal anticoagulant-related hematomas. Semin Ultrasound CT MR. 2006;27(2):117-25.18. M. A. Abbas, J. M. Collinsand K. W. Olden. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol. 2002;179(6):1389-94.19. A. Dohan, L. Darnige, M. Sapoval, et al. Spontaneous soft tissue hematomas. Diagn Interv Imaging. 2015;96(7-8):789-96.20. A. Smithson, J. Ruiz, R. Perello, et al. Diagnostic and management of spontaneous rectus sheath hematoma. Eur J Intern Med. 2013;24(6):579-82.21. J. E. Fitzgerald, L. A. Fitzgerald, F. E. Anderson, et al. The changing nature of rectus sheath haematoma: case series and literature review. Int J Surg. 2009;7(2):150-4.22. J. Donaldson, C. H. Knowles, S. K. Clark, et al. Rectus sheath haematoma associated with low molecular weight heparin: a case series. Ann R Coll Surg Engl. 2007;89(3):309-12.23. J. D. Berna, V. Garcia-Medina, J. Guirao, et al. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging. 1996;21(1):62-4.24. W. X. Fan, Z. X. Deng, F. Liu, et al. Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents. J Zhejiang Univ Sci B. 2012;13(5):408-12.25. D. Y. Won, S. D. Kim, S. C. Park, et al. Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation. Yonsei Med J. 2011;52(2):358-61.26. M. Lubner, C. Menias, C. Rucker, et al. Blood in the belly: CT findings of hemoperitoneum. Radiographics. 2007;27(1):109-25.27. H. Podgerand M. Kent. Femoral nerve palsy associated with bilateral spontaneous iliopsoas haematomas: a complication of venous thromboembolism therapy. Age Ageing. 2016;45(1):175-6.28. D. Une, S. Shimizuand K. Nakanishi. Bilateral iliopsoas hematomas under sedation: a complication of postoperative therapy after coronary artery bypass grafting. Acta Med Okayama. 2010;64(1):71-3.29. G. Gayer, T. S. Desser, M. Hertz, et al. Spontaneous suburothelial hemorrhage in coagulopathic patients: CT diagnosis. AJR Am J Roentgenol. 2011;197(5):W887-90.30. Sung Eun Rha, Jae Young Byun, Seung Eun Jung, et al. The Renal Sinus: Pathologic Spectrum and Multimodality Imaging Approach1. radiographics. 2004;24(1):117-31.31. P. Brar, I. Singh, S. Kaur, et al. Anticoagulant-induced intramural hematoma of the jejunum. Clin J Gastroenterol. 2011;4(6):387-90.32. A. Kawashima, C. M. Sandler, R. D. Ernst, et al. Imaging of Nontraumatic Hemorrhage of the Adrenal Gland. radiographics. 1999;19:949-63.33. A. C. Wilbur, L. D. Goldsteinand B. A. Prywitch. Hemorrhagic ovarian cysts in patients on anticoagulation therapy: CT findings. J Comput Assist Tomogr. 1993;17(4):623-5.34. P. Bernard, J. F. Gonzalez, J. Facione, et al. Haematoma of pectineus muscle after total hip arthroplasty. Ann Phys Rehabil Med. 2011;54(5):293-7.

Antikoagülan ilişkili abdominal hematomlarin: Klinik ve BT bulgulari

Yıl 2018, Cilt: 17 Sayı: 2, 50 - 61, 24.09.2018
https://doi.org/10.17941/agd.425110

Öz











Giriş ve Amaç: Antikoagülan ilişkili abdominal hematomların klinik
özelliklerini ve bilgisayarlı tomografi (BT) bulgularını değerlendirmeyi
amaçladık. Gereç ve Yöntem: Bu sistematik retrospektif çalışmaya Mart 2008 ile
Mayıs 2016 tarihleri arasında antikoagülan tedavi altında abdominal hematom
tanısı alan 55 hasta (
ortalama yaş: 66±12 yıl, aralık 29-84) dahil
edildi. Hastalar demografik özellikler, klinik belirtiler, tıbbi öykü, ilişkili
faktörler, biyokimyasal testler, BT bulguları, tedavi ve sonuçları açısından
değerlendirildi. Bulgular:
En sık kullanılan antikoagülan ajan
warfarin (%72.7) olmakla birlikte enoksaparin kullanımı %20 ve warfarinin
enoksaparin ile birlikte kullanımı % 7.3 oranlarında saptandı. Ana klinik
semptomlar karın ağrısı ve abdominal distansiyondu. Toplam 85 hematom alani saptandı
ve en sık görülen lokalizasyonlar rektus kas kılıfı (%50.9) ve gastrointestinal
sistem (% 30.9) olarak izlendi. Kontrol Antikoagülasyon Komitesinin kriterlerine
göre 15 (%27.3) hastada majör kanama saptandı. Sonuç: Antikoagülan ilişkili
abdominal hematomların sık görülen klinik ve BT bulgularının bilinmesi, hızlı
ve doğru tanı koymayı olanak sağlar. Aynı zamanda klinik hasta yönetiminde doğrudan
bir etkiye sahiptir.

Kaynakça

  • 1. S. D. O'Connor, A. J. Taylor, E. C. Williams, et al. Coagulation concepts update. AJR Am J Roentgenol. 2009;193(6):1656-64.2. M. Tonolini, S. Ippolito, F. Patella, et al. Hemorrhagic complications of anticoagulant therapy: role of multidetector computed tomography and spectrum of imaging findings from head to toe. Curr Probl Diagn Radiol. 2012;41(6):233-47.3. M. N. Levine, G. Raskob, S. Landefeld, et al. Hemorrhagic Complications of Anticoagulant Treatment. Chest. 2001;119(1):108S-21S.4. C. S. Landefeldand R. J. Beyth. Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med. 1993;95(3):315-28.5. L. N. Nazarian, A. S. Lev-Toaff, C. M. Spettell, et al. CT assessment of abdominal hemorrhage in coagulopathic patients: impact on clinical management. Abdominal Imaging. 1999;24:246-9.6. M. Fortina, S. Carta, E. O. Del Vecchio, et al. Retroperitoneal hematoma due to spontaneous lumbar artery rupture during fondaparinux treatment. Case report and review of the literature. Acta Biomed. 2007;78(1):46-50.7. I. Kocayigit, Y. Can, S. Sahinkus, et al. Spontaneous rectus sheath hematoma during rivaroxaban therapy. Indian J Pharmacol. 2014;46(3):339-40.8. S. Schulman, R. J. Beyth, C. Kearon, et al. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):257S-98S.9. V. M. Alla, S. M. Karnam, M. Kaushik, et al. Spontaneous rectus sheath hematoma. West J Emerg Med. 2010;11(1):76-9.10. A. Guven, G. Sokmen, E. Bulbuloglu, et al. Spontaneous abdominal hematoma in a patient treated with clopidogrel therapy: a case report. Ital Heart J. 2004;5(10):774-6.11. S. Schulman, C. Kearon, S. Subcommittee on Control of Anticoagulation of the, et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692-4.12. J. Ansell, J. Hirsh, J. Dalen, et al. Managing oral anticoagulant therapy. Chest. 2001;119(1 Suppl):22S-38S.13. J. H. Tapia-Perez, S. Gehring, R. Zilke, et al. Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg. 2014;118:37-43.14. M. Jun, M. T. James, B. J. Manns, et al. The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. BMJ. 2015;350:h246.15. S. J. Swensen, R. A. McLeodand D. H. Stephens. CT of extracranial hemorrhage and hematomas. AJR Am J Roentgenol. 1984;143(4):907-12.16. E. Gokce, M. Beyhanand B. Acu. Evaluation of Oral Anticoagulant-Associated Intracranial Parenchymal Hematomas Using CT Findings. Clin Neuroradiol. 2015;25(2):151-9.17. R. Zissin, M. Ellisand G. Gayer. The CT findings of abdominal anticoagulant-related hematomas. Semin Ultrasound CT MR. 2006;27(2):117-25.18. M. A. Abbas, J. M. Collinsand K. W. Olden. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol. 2002;179(6):1389-94.19. A. Dohan, L. Darnige, M. Sapoval, et al. Spontaneous soft tissue hematomas. Diagn Interv Imaging. 2015;96(7-8):789-96.20. A. Smithson, J. Ruiz, R. Perello, et al. Diagnostic and management of spontaneous rectus sheath hematoma. Eur J Intern Med. 2013;24(6):579-82.21. J. E. Fitzgerald, L. A. Fitzgerald, F. E. Anderson, et al. The changing nature of rectus sheath haematoma: case series and literature review. Int J Surg. 2009;7(2):150-4.22. J. Donaldson, C. H. Knowles, S. K. Clark, et al. Rectus sheath haematoma associated with low molecular weight heparin: a case series. Ann R Coll Surg Engl. 2007;89(3):309-12.23. J. D. Berna, V. Garcia-Medina, J. Guirao, et al. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging. 1996;21(1):62-4.24. W. X. Fan, Z. X. Deng, F. Liu, et al. Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents. J Zhejiang Univ Sci B. 2012;13(5):408-12.25. D. Y. Won, S. D. Kim, S. C. Park, et al. Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation. Yonsei Med J. 2011;52(2):358-61.26. M. Lubner, C. Menias, C. Rucker, et al. Blood in the belly: CT findings of hemoperitoneum. Radiographics. 2007;27(1):109-25.27. H. Podgerand M. Kent. Femoral nerve palsy associated with bilateral spontaneous iliopsoas haematomas: a complication of venous thromboembolism therapy. Age Ageing. 2016;45(1):175-6.28. D. Une, S. Shimizuand K. Nakanishi. Bilateral iliopsoas hematomas under sedation: a complication of postoperative therapy after coronary artery bypass grafting. Acta Med Okayama. 2010;64(1):71-3.29. G. Gayer, T. S. Desser, M. Hertz, et al. Spontaneous suburothelial hemorrhage in coagulopathic patients: CT diagnosis. AJR Am J Roentgenol. 2011;197(5):W887-90.30. Sung Eun Rha, Jae Young Byun, Seung Eun Jung, et al. The Renal Sinus: Pathologic Spectrum and Multimodality Imaging Approach1. radiographics. 2004;24(1):117-31.31. P. Brar, I. Singh, S. Kaur, et al. Anticoagulant-induced intramural hematoma of the jejunum. Clin J Gastroenterol. 2011;4(6):387-90.32. A. Kawashima, C. M. Sandler, R. D. Ernst, et al. Imaging of Nontraumatic Hemorrhage of the Adrenal Gland. radiographics. 1999;19:949-63.33. A. C. Wilbur, L. D. Goldsteinand B. A. Prywitch. Hemorrhagic ovarian cysts in patients on anticoagulation therapy: CT findings. J Comput Assist Tomogr. 1993;17(4):623-5.34. P. Bernard, J. F. Gonzalez, J. Facione, et al. Haematoma of pectineus muscle after total hip arthroplasty. Ann Phys Rehabil Med. 2011;54(5):293-7.
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Esin Kurtuluş Öztürk 0000-0001-6046-3486

Berat Acu Bu kişi benim 0000-0001-9590-1052

Saffet Öztürk 0000-0002-5221-4831

Murat Beyhan Bu kişi benim 0000-0002-8630-4632

Erkan Gökçe 0000-0002-1809-2172

Orhan Önalan Bu kişi benim 0000-0001-9780-7051

Yayımlanma Tarihi 24 Eylül 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 17 Sayı: 2

Kaynak Göster

APA Kurtuluş Öztürk, E., Acu, B., Öztürk, S., Beyhan, M., vd. (2018). Anticoagulant related abdominal hematomas: Clinical and CT findings. Akademik Gastroenteroloji Dergisi, 17(2), 50-61. https://doi.org/10.17941/agd.425110

test-5