J Korean Soc Emerg Med.  2014 Jun;25(3):307-311.

Retroperitoneal Hematoma due to Spontaneous Rupture of Lumbar Artery in Patients Taking Anticoagulant and/or Antiplatelet: A Retrospective Analysis

• Choi K
• Kwak J

Abstract

PURPOSE
The main purpose of this study was to achieve a broad perspective of the clinical problem with regard to its overall presentation and relation to anticoagulant and antiplatelet therapy, and to describe common management strategies and clinical outcomes.
METHODS
We initially screened 262 patients who were admitted from the Emergency Department between June, 1996 and June, 2013, with International Classification of Diseases code of K66.1 (hemoperitoneum), R58 (retroperitoneal hemorrhage) and D68.3 (hemorrhagic disorder due to anticoagulants). We excluded patients with retroperitoneal hemorrhage (RH) associated with trauma, vascular lesions, tumors, liver cirrhosis, renal failure, and surgical complications. A total of 24 adult patients were found to have retroperitoneal hematoma due to spontaneous lumbar artery rupture and were included in the study for further analysis.
RESULTS
Male to female ratio was 14:10 and the mean age was 75.3+/-10.4 years old. Overall, 19 patients (79.1%) were taking warfarin, 20 patients (83.3%) were taking aspirin and/or clopidogrel, and 15 patients (62.5%) were taking both anticoagulant and antiplatelet medications. The most common presenting symptom was acute back pain. CT scan showed extravasation of contrast in 20 patients. The mean hematoma size was 12.5+/-6.4 cm. Eleven patients (55%) underwent arterial embolization and 22 patients (91.6%) received blood transfusion. No surgical intervention was performed.
CONCLUSION
Retroperitoneal hematomas caused by spontaneous rupture of the lumbar artery showed a strong association with use of anticoagulant and/or antiplatelet therapy. For patients, particularly elderly patients, who present with acute back pain or hemodynamic instability and who are on anticoagulant and/or antiplatelet therapy, ER physicians should consider retroperitoneal hematoma as a differential diagnosis and to rule it out vigilantly.

Keyword

Retroperitoneal space; Hematoma; Anticoagulants; Antiplatelet agents

MeSH Terms

Adult
Aged
Anticoagulants
Arteries*
Aspirin
Back Pain
Blood Transfusion
Diagnosis, Differential
Emergency Service, Hospital
Female
Hematoma*
Hemodynamics
Hemorrhage
Humans
International Classification of Diseases
Liver Cirrhosis
Male
Platelet Aggregation Inhibitors
Renal Insufficiency
Retroperitoneal Space
Retrospective Studies*
Rupture
Rupture, Spontaneous*
Tomography, X-Ray Computed
Warfarin
Anticoagulants
Aspirin
Platelet Aggregation Inhibitors
Warfarin