Embolization vs. conservative management for spontaneous abdominal or pelvic hemorrhage

Mitchell MD, Trerotola SO, Mull NK
Record ID 32018005320
Authors' objectives: Identify and summarize evidence on outcomes for patients with spontaneous abdominal or pelvic hemorrhage treated with embolization.
Authors' results and conclusions: EVIDENCE SUMMARY  Rectus sheath hematoma, ileo-psoas hematoma, and other bleeding events can occur spontaneously in patients taking anticoagulant medications. They can be treated with vascular embolization to seal the source of bleeding, or they can be managed in a conservative manner with reversal of anticoagulation, fluid resuscitation, and blood replacement as necessary.  American College of Radiology guidelines recommend CT angiography for identifying the site of retroperitoneal bleeding and determining whether bleeding is ongoing, but they do not make recommendations regarding treatment. We found no other guidelines addressing this condition.  The evidence base on management of this condition is made up entirely of cohort studies, most of which are small, plus individual case reports. There are no prospective studies comparing embolization to conservative management.  While some studies report higher mortality for patients managed with embolization, they are all severely confounded by differences between patients receiving embolization and patients managed conservatively. We are unable to draw any conclusions about the comparative safety and effectiveness of the two strategies.  Active and more severe bleeding is associated with increased failure of conservative therapy. Where investigators reported criteria for selecting patients for embolization, active bleeding as evidenced by contrast extravasation was most important. A points-based scoring system (Table 10) has been proposed to identify those patients believed to be at greatest risk for adverse outcomes when managed conservatively, but there have been no prospective studies measuring its performance.
Project Status: Completed
Year Published: 2023
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: United States
MeSH Terms
  • Angiography
  • Embolization, Therapeutic
  • Hematoma
  • Hemorrhage
  • Gastrointestinal Hemorrhage
  • Anticoagulants
  • retroperitoneal
  • rectus sheath
  • angiography
  • anticoagulation
  • hematoma
Organisation Name: Penn Medicine Center for Evidence-based Practice
Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104
Contact Name: Nikhil Mull
Contact Email: cep@pennmedicine.upenn.edu
Copyright: <p>Center for Evidence-based Practice (CEP)</p>
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