From the Guidelines
Treatment of a large hematoma identified on ultrasound should prioritize minimizing morbidity, mortality, and improving quality of life, with surgical intervention such as endoscopic aspiration being a viable option for large, symptomatic hematomas, as it has been shown to significantly lower mortality rates and improve outcomes in certain patient groups 1.
Key Considerations
- The location, size, and symptoms of the hematoma are crucial in determining the best course of treatment.
- For stable, non-expanding hematomas, conservative management may be sufficient, including rest, ice application, compression, and elevation of the affected area.
- Large, symptomatic, or expanding hematomas may require more aggressive treatment, such as drainage through aspiration or surgical evacuation, to prevent complications and improve outcomes.
Treatment Options
- Endoscopic aspiration has been studied in small, single-center randomized trials, showing promising results in reducing mortality rates and improving quality of life in patients with large hematomas 1.
- Ultrasound-guided drainage is often preferred for its real-time visualization capabilities, allowing for more precise and effective drainage.
- The use of fibrinogen concentrate, cryoprecipitate, and platelet transfusions may also be considered in the management of major bleeding and coagulopathy following trauma 1.
Patient Monitoring
- Patients should be closely monitored for signs of complications, such as increasing pain, swelling, warmth, redness, fever, or expansion of the hematoma, and seek immediate medical attention if these symptoms occur.
- Regular follow-up appointments and imaging studies may be necessary to assess the resolution of the hematoma and detect any potential recurrence.
From the Research
Treatment Options for Large Hematoma
- Ultrasound-guided suction technique is a safe and effective method for treating large hematomas, as seen in a case report of a 21-year-old military recruit with a large submuscular buttock hematoma 2.
- For patients treated with oral anticoagulants, reversal of anticoagulation is crucial in cases of severe bleeding, and techniques such as infusion of vitamin K, replacement of blood components, and use of specific reversal agents like idarucizumab and andexanet alfa may be employed 3.
Management of Anticoagulation Agents
- The management of anticoagulation agents in trauma patients requires awareness of drug mechanisms, assays to determine drug activity, and appropriate reversal strategies 4.
- In cases of intracerebral hemorrhage related to oral anticoagulant therapy, treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates may be compared in terms of hematoma growth and outcome 5.
Imaging and Diagnosis
- CT findings are important in the accurate determination of the presence or absence of an anticoagulant-related bleed, its extent, and its precise location, particularly in cases of abdominal anticoagulant-related hematomas 6.