Risk factors for the development of retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices

• Published in: Journal of the American College of Cardiology Vol. 45; no. 3; pp. 363 - 368
• Main Authors: Farouque, H.M. Omar, Tremmel, Jennifer A., Raissi Shabari, Farshad, Aggarwal, Meenakshi, Fearon, William F., Ng, Martin K.C., Rezaee, Mehrdad, Yeung, Alan C., Lee, David P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2005; Elsevier Science; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Biological and medical sciences; Body Surface Area; Cardiology; Cardiology. Vascular system; Case-Control Studies; Drug therapy; Female; Femoral Artery - surgery; Heart attacks; Hematoma - etiology; Hospitals; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Postoperative Hemorrhage - etiology; Retroperitoneal Space; Risk Factors; Suture Techniques; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Veins & arteries; BSA; GP; OR; RPH; PCI; Urinary system disease; Closure; Angioplasty; Device; Coronary artery; Glycoprotein IIb; Instrumentation therapy; Retroperitoneal disease; Glycoprotein IIIa; Retroperitoneal hematoma; Blood vessel; Risk factor; Development; Fibrinolytic
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.10.042

We sought to determine the incidence, clinical features, and risk factors for retroperitoneal hematoma (RPH) after percutaneous coronary intervention (PCI). Little is known about the clinical features, outcomes, and determinants of this serious complication in the contemporary era of PCI. A retrospective analysis yielded 26 cases of RPH out of 3,508 consecutive patients undergoing PCI between January 2000 and January 2004. Cases were compared with a randomly selected sample of 50 control subjects without RPH. The incidence of RPH was 0.74%. Features of RPH included abdominal pain (42%), groin pain (46%), back pain (23%), diaphoresis (58%), bradycardia (31%), and hypotension (92%). The mean systolic blood pressure nadir was 75 mm Hg. The hematocrit dropped by 11.5 ± 5.1 points from baseline in RPH patients, as compared with 2.3 ± 3.3 points in controls (p < 0.0001). The mean hospital stay was longer in RPH patients (2.9 ± 3.8 days vs. 1.7 ± 1.5 days, p = 0.06). The following variables were found to be independent predictors of RPH: female gender (odds ratio [OR] 5.4, p = 0.005), low body surface area (BSA <1.73 m2; OR 7.1, p = 0.008), and higher femoral artery puncture (OR 5.3, p = 0.013). There was no association between RPH and arterial sheath size, use of glycoprotein IIb/IIIa inhibitors, or deployment of a vascular closure device. Female gender, low BSA, and higher femoral artery puncture are significant risk factors for RPH. Awareness of the determinants and clinical features of RPH may aid in prevention, early recognition, and prompt treatment.