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Semin intervent Radiol 2020; 37(01): 024-030
DOI: 10.1055/s-0039-3402017
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Approach to and Work-up of Bleeding Patients

Shantanu Warhadapande
1   Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Sean R. Dariushnia
2   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Nima Kokabi
2   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
William G. O'Connell
2   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Janice M. Newsome
2   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Laura K. Findeiss
2   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Bill S. Majdalany
2   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

Publication Date:
04 March 2020 (online)

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Abstract

A bleeding patient is a common consult for interventional radiologists. Prompt triage, preprocedural evaluation specific to the site of hemorrhage, and knowledge of resuscitative strategies allow for a potentially life-saving procedure to be appropriately and safely performed. Having a firm understanding of the clinical work-up and management of a bleeding patient has never been more important. In this article, a discussion of the clinical approach and work-up of a bleeding patient for whom interventional radiology is consulted is followed by a discussion of etiology-specific preprocedural work-up.

Keywords

interventional radiology - trauma - hemorrhage - embolization - clinical approach - bleeding

Disclosures

Z.L.B.: Coulter Grant recipient, speaker for Terumo.


R.M.E.: Speaker for Terumo.


The remainder of the authors have no relevant disclosures.


Notes

All authors have read and contributed to this manuscript.


 

  • References

  • 1 American College of Surgeon's Committee on Trauma. Advanced Trauma Life Support® (ATLS®) Student manual 10th ed. Chicago, IL: American College of Surgeon; 2018
    Search in Google Scholar
  • 2 Mitra B, Tullio F, Cameron PA, Fitzgerald M. Trauma patients with the ‘triad of death’. Emerg Med J 2012; 29 (08) 622-625
    CrossrefPubMedSearch in Google Scholar
  • 3 Hess JR, Ramos PJ, Sen NE. , et al. Quality management of a massive transfusion protocol. Transfusion 2018; 58 (02) 480-484
    CrossrefPubMedSearch in Google Scholar
  • 4 Callum JL, Rizoli S. Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management. Hematology (Am Soc Hematol Educ Program) 2012; 2012: 522-528
    CrossrefPubMedSearch in Google Scholar
  • 5 Curry NS, Davenport R, Pavord S. , et al. The use of viscoelastic haemostatic assays in the management of major bleeding: a British Society for Haematology Guideline. Br J Haematol 2018; 182 (06) 789-806
    CrossrefPubMedSearch in Google Scholar
  • 6 Patel IJ, Rahim S, Davidson JC. , et al. Society of Interventional Radiology Consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
    CrossrefPubMedSearch in Google Scholar
  • 7 Jaffe TA, Raiff D, Ho LM, Kim CY. Management of anticoagulant and antiplatelet medications in adults undergoing percutaneous interventions. AJR Am J Roentgenol 2015; 205 (02) 421-428 [Review. Erratum in: AJR Am J Roentgenol 2017;208(5):1176]
    CrossrefPubMedSearch in Google Scholar
  • 8 Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intra-abdominal injury?. JAMA 2012; 307 (14) 1517-1527
    CrossrefPubMedSearch in Google Scholar
  • 9 Chung JH, Cox CW, Mohammed TL. , et al. ACR appropriateness criteria blunt chest trauma. J Am Coll Radiol 2014; 11 (04) 345-351
    CrossrefPubMedSearch in Google Scholar
  • 10 Sudakoff GS, Rosen MP, Rybicki FJ. , et al. ACR Appropriateness Criteria® Blunt Abdominal Trauma. Available at: https://acsearch.acr.org/docs/69409/Narrative/ . Accessed September 1, 2019
    PubMed
  • 11 Coccolini F, Catena F, Moore EE. , et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016; 11: 50
    CrossrefPubMedSearch in Google Scholar
  • 12 Coccolini F, Montori G, Catena F. , et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 2017; 12: 40
    CrossrefPubMedSearch in Google Scholar
  • 13 Demetriades D, Hadjizacharia P, Constantinou C. , et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 2006; 244 (04) 620-628
    PubMedSearch in Google Scholar
  • 14 Duchesne J, Costantini TW, Khan M. , et al. The effect of hemorrhage control adjuncts on outcome in severe pelvic fracture: a multi-institutional study. J Trauma Acute Care Surg 2019; 87 (01) 117-124
    CrossrefPubMedSearch in Google Scholar
  • 15 Mohseni S, Talving P, Kobayashi L. , et al. The diagnostic accuracy of 64-slice computed tomography in detecting clinically significant arterial bleeding after pelvic fractures. Am Surg 2011; 77 (09) 1176-1182
    PubMedSearch in Google Scholar
  • 16 Coccolini F, Stahel PF, Montori G. , et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 2017; 12: 5
    CrossrefPubMedSearch in Google Scholar
  • 17 Schenker MP, Majdalany BS, Funaki BS. , et al. ACR appropriateness Criteria® on upper gastrointestinal bleeding. J Am Coll Radiol 2010; 7 (11) 845-853
    CrossrefPubMedSearch in Google Scholar
  • 18 Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am 2008; 92 (03) 491-509 , xi
    CrossrefPubMedSearch in Google Scholar
  • 19 Barkun A, Bardou M, Marshall JK. ; Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003; 139 (10) 843-857
    PubMedSearch in Google Scholar
  • 20 Chan WH, Khin LW, Chung YF, Goh YC, Ong HS, Wong WK. Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding. Br J Surg 2011; 98 (05) 640-644
    CrossrefPubMedSearch in Google Scholar
  • 21 Stollman NH, Putcha RV, Neustater BR, Tagle M, Raskin JB, Rogers AI. The uncleared fundal pool in acute upper gastrointestinal bleeding: implications and outcomes. Gastrointest Endosc 1997; 46 (04) 324-327
    CrossrefPubMedSearch in Google Scholar
  • 22 Adler DG, Leighton JA, Davila RE. , et al; ASGE. ASGE guideline: the role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointest Endosc 2004; 60 (04) 497-504
    CrossrefPubMedSearch in Google Scholar
  • 23 Rollhauser C, Fleischer DE. Nonvariceal upper gastrointestinal bleeding. Endoscopy 2002; 34 (02) 111-118
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am 2005; 34 (04) 643-664
    CrossrefPubMedSearch in Google Scholar
  • 25 Gostout CJ, Wang KK, Ahlquist DA. , et al. Acute gastrointestinal bleeding. Experience of a specialized management team. J Clin Gastroenterol 1992; 14 (03) 260-267
    CrossrefPubMedSearch in Google Scholar
  • 26 Dusold R, Burke K, Carpentier W, Dyck WP. The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding. Am J Gastroenterol 1994; 89 (03) 345-348
    PubMedSearch in Google Scholar
  • 27 Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 2003; 228 (03) 743-752
    CrossrefPubMedSearch in Google Scholar
  • 28 Brinson GM, Noone PG, Mauro MA. , et al. Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis. Am J Respir Crit Care Med 1998; 157 (6, Pt 1): 1951-1958
    CrossrefPubMedSearch in Google Scholar
  • 29 Ibrahim WH. Massive haemoptysis: the definition should be revised. Eur Respir J 2008; 32 (04) 1131-1132
    PubMedSearch in Google Scholar
  • 30 Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB. Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR Am J Roentgenol 2001; 177 (04) 861-867
    CrossrefPubMedSearch in Google Scholar
  • 31 Cahill BC, Ingbar DH. Massive hemoptysis. Assessment and management. Clin Chest Med 1994; 15 (01) 147-167
    PubMedSearch in Google Scholar
  • 32 Márquez-Martín E, Vergara DG, Martín-Juan J, Flacón AR, Lopez-Campos JL, Rodríguez-Panadero F. Endobronchial administration of tranexamic acid for controlling pulmonary bleeding: a pilot study. J Bronchology Interv Pulmonol 2010; 17 (02) 122-125
    CrossrefPubMedSearch in Google Scholar
  • 33 Fekri MS, Hashemi-Bajgani SM, Shafahi A, Zarshenas R. Comparing adrenaline with tranexamic acid to control acute endobronchial bleeding: a randomized controlled trial. Iran J Med Sci 2017; 42 (02) 129-135
    PubMedSearch in Google Scholar
  • 34 Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment. Chest 2001; 119 (1, Suppl): 108S-121S
    CrossrefPubMedSearch in Google Scholar
  • 35 Berná JD, Garcia-Medina V, Guirao J, Garcia-Medina J. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging 1996; 21 (01) 62-64
    CrossrefPubMedSearch in Google Scholar
  • 36 Salemis NS, Gourgiotis S, Karalis G. Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study. Int J Surg 2010; 8 (04) 290-293
    CrossrefPubMedSearch in Google Scholar
  • 37 Sheth HS, Kumar R, DiNella J, Janov C, Kaldas H, Smith RE. Evaluation of risk factors for rectus sheath hematoma. Clin Appl Thromb Hemost 2016; 22 (03) 292-296
    CrossrefPubMedSearch in Google Scholar
  • 38 Chan YC, Morales JP, Reidy JF, Taylor PR. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery?. Int J Clin Pract 2008; 62 (10) 1604-1613
    PubMedSearch in Google Scholar
  • 39 Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186
    CrossrefPubMedSearch in Google Scholar
  • 40 Marshall AL, Durani U, Bartley A. , et al. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a national inpatient sample-based analysis. Am J Obstet Gynecol 2017; 217 (03) 344.e1-344.e6
    CrossrefPubMedSearch in Google Scholar
  • 41 Mhyre JM, Shilkrut A, Kuklina EV. , et al. Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007. Obstet Gynecol 2013; 122 (06) 1288-1294
    CrossrefPubMedSearch in Google Scholar
  • 42 Prata N, Gerdts C. Measurement of postpartum blood loss. BMJ 2010; 340: c555
    CrossrefPubMedSearch in Google Scholar
  • 43 Li XF, Fortney JA, Kotelchuck M, Glover LH. The postpartum period: the key to maternal mortality. Int J Gynaecol Obstet 1996; 54 (01) 1-10
    CrossrefPubMedSearch in Google Scholar
  • 44 WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389 (10084): 2105-2116 [Erratum in: Lancet 2017; 389(10084): 2104]
    CrossrefPubMedSearch in Google Scholar
  • 45 Descargues G, Mauger Tinlot F, Douvrin F, Clavier E, Lemoine JP, Marpeau L. Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage. Hum Reprod 2004; 19 (02) 339-343
    CrossrefPubMedSearch in Google Scholar