What is the treatment for hematoma?

From the Guidelines

The treatment of a hematoma should prioritize controlling hemorrhage and managing coagulopathy, with the administration of tranexamic acid 1 g immediately, and the use of blood products such as red blood cells and fresh frozen plasma in a ratio of 1:1 to replace fluid volume, as recommended by the most recent guidelines 1.

Key Considerations

• The size, location, and severity of the hematoma will guide the treatment approach, with minor hematomas often managed conservatively and larger ones potentially requiring surgical intervention.
• The use of antifibrinolytic agents, such as tranexamic acid, may be beneficial in reducing bleeding, especially in trauma-induced coagulopathy 1.
• Surgical drainage may be necessary for larger hematomas or those in sensitive locations, with endoscopic aspiration being a potential option for supratentorial hemorrhages 1.

Management Strategies

• For minor hematomas, the RICE method (Rest, Ice, Compression, Elevation) can be effective in managing symptoms and promoting healing.
• Over-the-counter pain medications, such as acetaminophen or ibuprofen, can help manage pain and reduce inflammation.
• Monitoring for signs of infection or compartment syndrome is crucial, as these complications require immediate medical attention.

Evidence-Based Recommendations

• The administration of blood products, such as red blood cells and fresh frozen plasma, should be guided by laboratory or point-of-care tests of coagulation, with a ratio of 1:1 recommended for replacing fluid volume 1.
• The use of tranexamic acid should be considered in the treatment of bleeding trauma patients, with a dose of 1 g immediately, and avoidance of use if more than 3 hours after injury, unless there is ongoing evidence of hyperfibrinolysis 1.

From the Research

Treatment Options for Hematoma

The treatment for hematoma can vary depending on the location, size, and severity of the hematoma, as well as the patient's overall health. Some studies suggest the following treatment options:

• Conservative management, which may include monitoring and supportive care, as seen in a case of sublingual hematoma that was treated conservatively 2
• Reversal of coagulopathy using intravenous administration of vitamin K and fresh frozen plasma, as reported in a case of sublingual hematoma secondary to excessive anticoagulation 2
• Surgical intervention, such as tracheostomy or cricothyroidectomy, in cases where the airway is unstable 2
• Use of fresh frozen plasma and intravenous menatetrenon to improve abnormal bleeding and disorder of prothrombin activity (PT) and activated partial thromboplastin time (aPTT) in cases of epidural hematoma caused by coagulopathy 3

Surgical vs. Conservative Treatment

Some studies compare the effectiveness of surgical and conservative treatment for traumatic acute subdural haematoma:

• A prospective, observational, comparative effectiveness study found that a treatment strategy preferring acute surgical evacuation over initial conservative treatment was not associated with better functional outcome 4
• A case report of a patient with a significant left fronto-parietal epidural hematoma who refused surgery and was managed conservatively with a favorable clinical outcome suggests that conservative treatment may be a viable option in some cases 5

Management of Traumatic Hematoma

The management of traumatic hematoma may involve:

• Compression, tourniquets, pelvic binders, and rapid transport to a certified trauma center 6
• Early use of tourniquets and external pelvic stabilization to reduce transfusion requirement and mortality 6
• Goal-oriented, individualized therapy, including the use of point-of-care viscoelastic test procedures, to control bleeding and support clotting function 6
• Use of antidotes, such as idarucizumab and andexanet alpha, to reverse the effects of anticoagulant medications 6