Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy.
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy.
Medicina (Kaunas). 2023 Jul 19;59(7):1333. doi: 10.3390/medicina59071333.
: Transcatheter arterial embolization (TAE) is the mainstay of treatment for acute major hemorrhage, even in patients with coagulopathy and spontaneous bleeding. Coagulopathy is associated with worsening bleeding severity and higher mortality and clinical failure rates. Furthermore, some unanswered questions remain, such as the definition of coagulopathy, the indication for TAE or conservative treatment, and the choice of embolic agent. This study aims to assess the efficacy and safety of TAE for spontaneous non-neurovascular acute bleeding in patients with coagulopathy. : This study is a multicenter analysis of retrospectively collected data of consecutive patients with coagulopathy who had undergone, from January 2018 to May 2023, transcatheter arterial embolization for the management of spontaneous hemorrhages. : During the study interval (January 2018-May 2023), 120 patients with coagulopathy underwent TAE for spontaneous non-neurovascular acute bleeding. The abdominal wall was the most common bleeding site (72.5%). The most commonly used embolic agent was polyvinyl alcohol (PVA) particles or microspheres (25.0%), whereas coils and gelatin sponge together accounted for 32.5% of the embolic agents used. Technical success was achieved in all cases, with a 92.5% clinical success rate related to 9 cases of rebleeding. Complications were recorded in 12 (10%) patients. Clinical success was significantly better in the group of patients who underwent correction of the coagulopathy within 24 h of TAE. : Transcatheter arterial embolization (TAE) is effective and safe for the management of acute non-neurovascular bleeding in patients with coagulopathy. Correction of coagulopathy should not delay TAE and vice versa, as better clinical outcomes were noted in the subgroup of patients undergoing correction of coagulopathy within 24 h of TAE.
经导管动脉栓塞术（TAE）是治疗急性大出血的主要方法，即使在有凝血障碍和自发性出血的患者中也是如此。凝血障碍与出血严重程度的恶化以及更高的死亡率和临床失败率有关。此外，仍存在一些悬而未决的问题，例如凝血障碍的定义、TAE 或保守治疗的适应证以及栓塞剂的选择。本研究旨在评估 TAE 治疗伴有凝血障碍的自发性非神经血管急性出血的疗效和安全性。
本研究是对 2018 年 1 月至 2023 年 5 月期间连续因自发性出血接受 TAE 治疗的伴有凝血障碍的患者进行的回顾性数据分析。
在研究期间（2018 年 1 月至 2023 年 5 月），120 例伴有凝血障碍的患者因自发性非神经血管急性出血而行 TAE。腹壁是最常见的出血部位（72.5%）。最常使用的栓塞剂是聚乙烯醇（PVA）颗粒或微球（25.0%），而线圈和明胶海绵的栓塞剂共占 32.5%。所有病例均达到技术成功，临床成功率为 92.5%，与 9 例再出血相关。12 例（10%）患者出现并发症。在 TAE 后 24 小时内纠正凝血障碍的患者中，临床成功率显著更高。
经导管动脉栓塞术（TAE）对伴有凝血障碍的急性非神经血管出血的治疗是有效且安全的。纠正凝血障碍不应延迟 TAE，反之亦然，因为在 TAE 后 24 小时内纠正凝血障碍的患者亚组中观察到更好的临床结局。
