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Master Thesis

Embolisation artérielle versus traitement médical dans la prise en charge des hématomes musculaires abdomino-pelviens spontanés sous traitement anticoagulant

Abstract : Objectives: To compare the clinical presentation, biological and imaging findings of patients admitted for anticoagulant-related abdominal or pelvic muscle hematoma according to the management strategy. To evaluate efficacy and safety of conservative management and arterial embolization. Methods: Between 2015 and 2020, 219 patients were included and 62 were treated with arterial embolization. Demographic data, clinical and biological status at admission, CT findings and treatment elements were recorded. Clinical success was defined as bleeding cessation, hemodynamic stability and hemoglobin level stabilization. Univariate and multivariate analysis were performed to evaluate mortality. Results: Patients with severe initial presentation were mainly treated with embolization. Patients managed conservatively were receiving more vitamin K antagonists. Patients treated with embolization had larger hematomas, more contrast extravasation and muscular fascia ruptures on CT. Technical success rate of embolization was 93.5%. Clinical success rate was 75%. All cause 30-day mortality rate after embolization was 22.6%. Muscular fascia rupture and large hematoma volume were associated with an increased mortality. Conclusions: Embolization should be carried out immediately in hemodynamically unstable patients with a large hematoma, active bleeding, and/or muscular fascia rupture on CT. An overdose of anticoagulation therapy should always be corrected first. In patients with a less severe presentation, many factors should be taken into account for an optimal management.
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https://dumas.ccsd.cnrs.fr/dumas-03578826
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Submitted on : Thursday, February 17, 2022 - 3:35:51 PM
Last modification on : Saturday, April 2, 2022 - 3:38:36 AM
Long-term archiving on: : Wednesday, May 18, 2022 - 7:09:38 PM

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  • HAL Id : dumas-03578826, version 1

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Thibault Moyne. Embolisation artérielle versus traitement médical dans la prise en charge des hématomes musculaires abdomino-pelviens spontanés sous traitement anticoagulant. Médecine humaine et pathologie. 2021. ⟨dumas-03578826⟩

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