Is it normal to have a small hematoma at the wrist after an angiogram (angiography)?

From the Guidelines

Yes, it is normal to have a small hematoma at the wrist after an angiogram. A hematoma is a common complication of transradial coronary angiography and intervention, with the incidence of major vascular complications being low 1. According to the American Heart Association, TRA site hematomas are generally small and readily managed with manual compression, adjustment of compression band pressure, or repositioning of the compression band to a more proximal location 1.

Key Points to Consider

• Most small hematomas resolve on their own within a short period without specific treatment.
• To help manage the hematoma, gentle pressure can be applied to the site for the first few hours after the procedure.
• Elevation of the affected area when possible and application of cold compresses intermittently for the first 24 hours can help reduce swelling, then switching to warm compresses after 24 hours to aid in absorption.
• It is essential to monitor the hematoma and contact a healthcare provider if it continues to grow, becomes increasingly painful, feels warm to touch, or if fever develops, as these could indicate complications requiring medical attention 1.

Important Considerations

• Hematoma formation proximal to the access site may indicate arterial perforation, usually of a side branch, and forearm angiography at the conclusion of the case is strongly advised in such cases 1.
• In rare occasions, surgical repair of the laceration and evacuation of hematoma may be required to avoid compartment syndrome 1.

From the Research

Hematoma Formation After Angiogram

• Hematoma formation is a possible complication after angiogram procedures, particularly those involving transradial access 2, 3, 4.
• The incidence of forearm hematoma after transradial coronary interventions has been reported to be around 10% 3, 4.
• Factors that increase the risk of hematoma formation include:
  • Female gender 3
  • Multiple puncture attempts 3, 4
  • Intensive antiplatelet therapy 3, 4
  • Complex procedure 3
  • Longer hemostasis time 3
  • Age 4
  • Body mass index 4
  • Nonclopidogrel agent use for dual antiplatelet therapy 4
  • Multiple catheter exchanges 4

Management and Prevention of Hematoma

• The use of hemostatic devices, such as kaolin-based hemostatic pads, has been studied as a means to reduce the risk of hematoma formation 5.
• The optimal duration of hemostatic compression post transradial access is controversial, but a target of 2 hours is typically used 6.
• A mixed treatment comparison meta-analysis of randomized trials found that a hemostasis duration of 2 hours offers the best balance for efficacy and safety 6.
• Patients should be monitored for signs of hematoma formation, such as pain, swelling, or bruising, after the procedure 3, 4.