• Vincenzo G Menditto, Francesca Fulgenzi, Sirio Lombardi, Anna Dimitriadou, Cinzia Mincarelli, Marzia Rosati, Roberto Candelari, Giovanni Pomponio, Aldo Salvi, and Armando Gabrielli.
• Medicina d'Urgenza, Ospedali Riuniti di Ancona, Italy. Electronic address: v.menditto@univpm.it.
• Am J Emerg Med. 2018 Dec 1; 36 (12): 2177-2181.

Study ObjectiveThe optimal management of patients receiving heparin, warfarin or direct anti-coagulant therapy who experience spontaneous, severe, life-threatening soft-tissue hemorrhage (SSTH) is unclear. The purpose of this study is to investigate efficacy and safety of the interventional protocol implemented in our department.MethodsIn this retrospective cohort study, we analyzed data from 80 consecutive patients with SSTH secondary to anticoagulation therapy diagnosed by the appropriate computed tomography scan. All patients received a structured clinical pathway, including aggressive resuscitation, reversal of coagulopathy when indicated, Interventional Radiology procedures by transcatheter embolization (TE), clinical observation and repeated laboratory controls.ResultsWe enrolled 80 patients from 2013 to 2017. Angiography was performed in 60 patients (75%). It revealed the bleeding site in 46 cases, and a TE was performed in all. The rates of technical success of TE, primary clinical success and bleeding control were 98% (45/46), 91% (73/80) and 89% (71/80) respectively. In 5 patients (6%) the control of the bleeding was obtained with a second TE. Short-term and 30-day mortality was 5% (4 patients) and 11% (9 patients), respectively. No adverse events were observed.ConclusionA structured clinical pathway, including TE seems to be an effective and safe method to manage the patients with SSTH due to anticoagulant treatment.Copyright © 2018 Elsevier Inc. All rights reserved.

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