Management of Spontaneous Hematomas in Anticoagulated Patients

Spontaneous haematomas in patients receiving anticoagulant therapy represent a formidable clinical challenge, owing to the dual imperatives of arresting active bleeding and mitigating thrombotic risk. These haematomas may arise in diverse anatomical compartments, including the rectus sheath, retroperitoneum and ilio-psoas region. Initial management focuses on haemodynamic stabilisation, reversal or modulation of anticoagulation and prompt imaging assessment, typically by contrast-enhanced computed tomography. In haemodynamically stable patients with small- to moderate-sized collections, conservative measures—such as bed rest, analgesia, blood product support and close laboratory monitoring—often suffice. Conversely, large or expanding haematomas, or those associated with ongoing bleeding, require percutaneous or surgical intervention. Endovascular techniques, notably percutaneous transarterial embolisation, have emerged as a life-saving option, offering high technical success rates while avoiding the morbidity of open surgery. Decision-making is guided by factors such as haematoma size, rate of haemoglobin drop, patient comorbidities and underlying coagulation status. The global significance of optimised care pathways is underscored by an ageing population, rising use of direct oral anticoagulants and the need to harmonise bleeding and thrombosis management in critical care and surgical settings.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Management of Spontaneous Hematomas in Anticoagulated Patients publication trend

The graph below shows the total number of articles in management of spontaneous hematomas in anticoagulated patients across all publications each year (not limited to Nature Index journals).

Technical terms

Anticoagulation reversal: Interventions to restore normal coagulation, including vitamin K, fresh frozen plasma or prothrombin complex concentrates.

Percutaneous transarterial embolisation: An endovascular procedure that occludes bleeding vessels via catheter-directed embolic agents.

Computed tomography angiography (CTA): Contrast-enhanced imaging modality used to localise active bleeding and plan interventions.

Rectus sheath haematoma: Accumulation of blood within the rectus abdominis muscle sheath, often precipitated by anticoagulation or minor trauma.

Retroperitoneal haematoma: Bleeding into the retroperitoneal space, which may be occult and present with non-specific symptoms.

Haemodynamic stabilisation: Restoration and maintenance of adequate circulation through fluid resuscitation, transfusion and vasopressors as needed.

References

1. The prominent role of percutaneous transarterial embolization in the treatment of anterior abdominal wall hematomas: the results of three high volume tertiary referral centers. La radiologia medica (2023).
2. A Proposed Algorithm on the Modern Management of Rectus Sheath Hematoma: A Literature Review. Cureus (2021).
3. Spontaneous Retroperitoneal Hematoma Treated with Percutaneous Transarterial Embolization in COVID-19 Era: Diagnostic Findings and Procedural Outcome. Tomography (2022).