A Multicenter Retrospective Cohort Study Evaluating the Clinical Outcomes of Patients with Coagulopathy Undergoing Transcatheter Arterial Embolization (TAE) for Acute Non-Neurovascular Bleeding
Roberto Minici,
Federico Fontana,
Massimo Venturini,
Giuseppe Guzzardi,
Filippo Piacentino,
Marco Spinetta,
Bernardo Bertucci,
Raffaele Serra,
Davide Costa,
Nicola Ielapi,
Andrea Coppola,
Pasquale Guerriero,
Biagio Apollonio,
Rita Santoro,
MGJR Research Team,
Luca Brunese,
Domenico Laganà
Affiliations
Roberto Minici
Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
Federico Fontana
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Massimo Venturini
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Giuseppe Guzzardi
Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
Filippo Piacentino
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Marco Spinetta
Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
Bernardo Bertucci
Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
Raffaele Serra
Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
Davide Costa
Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
Nicola Ielapi
Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy
Andrea Coppola
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Pasquale Guerriero
Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy
Biagio Apollonio
Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy
Rita Santoro
Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy
MGJR Research Team
Magna Graecia Junior Radiologists Research Team, 88100 Catanzaro, Italy
Luca Brunese
Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
Domenico Laganà
Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
Background and Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.
