The Outcome of Conservative and Endovascular Embolization of Spontaneous Intra-abdominal Bleeding Related to Anticoagulants/Antiplatelets

Purpose: Spontaneous intraabdominal hemorrhage, particularly in the context of anticoagulant and antiplatelet therapy, poses a clinical challenge. This retrospective study aimed to evaluate the effectiveness of different management strategies for such patients and explore the clinical outcomes related to these treatments.

Materials and Methods: A retrospective analysis of 33 patients presenting with spontaneous intraabdominal hemorrhage was conducted at a tertiary care center. Patient demographics, clinical characteristics, laboratory findings, treatment modalities (conservative management, endovascular embolization), and outcomes were evaluated. Comparative statistical analyses were performed to assess the impact of treatment approaches on patient outcomes.

Results: The majority of patients were female (72.7%) and of Saudi nationality (72.7%). Warfarin (21.2%) and heparin (21.2%) were the most frequently prescribed anticoagulants. The study demonstrated a significant postoperative reduction in systolic blood pressure (p = 0.031), indicating the effectiveness of timely intervention. Furthermore, the conservative management approach showed significant preoperative and postoperative improvements in systolic blood pressure, hemoglobin levels, and platelet counts compared with endovascular embolization. Blood transfusion volumes were significantly lower in the conservative management group (p = 0.002). The presence of rebleeding postoperatively was borderline significant (p = 0.074), favoring patients undergoing endovascular embolization.

Conclusion: Effective management of spontaneous intraabdominal hemorrhage in anticoagulated and antiplatelet-treated patients is a multifaceted challenge. The study's results emphasize the importance of timely intervention, hemodynamic stability, and individualized treatment approaches. Further research is needed to validate and expand upon these findings, ultimately improving patient outcomes in this clinical scenario.

Publication History

Article published online:
02 April 2024