At day 15 after femoral cardiac catheterization, what activities can an adult patient with a groin hematoma (first noted day 7, no pseudoaneurysm) safely resume while on antiplatelet therapy?

Activity Recommendations at Day 15 Post-Catheterization with Resolved Groin Hematoma

At day 15 post-femoral catheterization with a stable, non-pulsatile groin hematoma and confirmed absence of pseudoaneurysm, you may resume gradual ambulation and light daily activities while continuing aspirin, but avoid strenuous exercise, heavy lifting, and prolonged hip flexion for at least one additional week. 1

Prerequisite Confirmation Before Activity Advancement

Before permitting increased activity at day 15, you must verify:

• Repeat duplex ultrasound at 7-10 days confirmed no pseudoaneurysm formation (the initial day-7 ultrasound showing no pseudoaneurysm is insufficient alone for activity clearance at day 15). 1

• Serial physical examinations demonstrate the hematoma is stable or decreasing in size, with no new pulsatile quality, no expanding mass, and no increasing pain. 1

• Bilateral pedal pulses remain symmetric and Doppler systolic blood pressures are equivalent between legs. 2

Permitted Activities at Day 15

Safe to Resume:

• Normal ambulation and walking without distance restrictions 1
• Activities of daily living including showering, dressing, and light household tasks 3
• Sitting for normal meal duration (30-45 minutes) with periodic standing breaks 1
• Driving short distances if not taking narcotic pain medications 3

Continue to Avoid Until Day 21-28:

• Strenuous exercise, running, or aerobic activity that elevates heart rate significantly 1
• Heavy lifting (>10-15 pounds), pushing, or pulling activities 1
• Prolonged sitting (>1 hour continuously) without standing breaks, as hip flexion raises intra-abdominal and femoral pressures that can stress the healing arterial wall 1
• Activities requiring Valsalva maneuvers (straining, heavy coughing without splinting the groin) 1

Critical Antiplatelet Management

Continue aspirin 75-100 mg daily without interruption. The cardiovascular risk of stopping aspirin—particularly stent thrombosis with its 25-30% mortality rate—far exceeds any bleeding risk from a stable, resolving hematoma. 1 Low-dose aspirin does not impede hematoma resolution, and high closure rates of vascular injuries are maintained despite ongoing antiplatelet therapy. 1

If the patient received a coronary stent, dual antiplatelet therapy (aspirin plus clopidogrel or other P2Y12 inhibitor) must be continued per the original post-PCI protocol, typically 3-6 months for newer-generation drug-eluting stents. 3 The combination of antiplatelet therapy and mechanical stress from activity makes gradual activity progression especially important. 1

Mandatory Surveillance Protocol

Weekly Clinical Assessment:

• Measure hematoma dimensions with calipers or marking pen to document stability or regression 1
• Palpate for any new pulsatile quality (conversion to pseudoaneurysm) 1
• Auscultate for new bruits over the femoral artery 1
• Assess for compressive symptoms: numbness, weakness, venous congestion, or distal limb color changes 1

One-Month Follow-Up Ultrasound:

Obtain duplex ultrasound at 1 month (day 28-30) for all femoral hematomas to document complete resolution and exclude delayed pseudoaneurysm formation, as 90% of pseudoaneurysms that will close spontaneously do so within 2 months, but delayed formation can occur. 1, 2

Red-Flag Symptoms Requiring Immediate Evaluation

Instruct the patient to return immediately or call emergency services if any of the following develop:

• New pulsatile mass or thrill at the groin site (signals pseudoaneurysm formation requiring urgent ultrasound-guided thrombin injection or surgical repair) 1
• Expanding hematoma despite activity restriction (suggests ongoing arterial bleeding) 1
• New numbness, weakness, or tingling in the leg (femoral nerve compression) 1
• Leg swelling, venous distension, or color changes (venous thrombosis or arterial compromise) 1
• Increasing pain disproportionate to the clinical findings 1
• Progressive skin changes: increasing ecchymosis, skin tension, or overlying erythema (may indicate impending rupture) 1

Common Pitfalls to Avoid

Do not allow unrestricted activity based solely on the patient feeling better or the absence of symptoms. Objective imaging confirmation of hematoma stability is required before advancing activity. 1 Physical examination alone misses more than 60% of catheter-related pseudoaneurysms. 1, 2

Do not assume a non-pulsatile mass excludes pseudoaneurysm. Thrombosed pseudoaneurysms may be non-pulsatile yet still require definitive treatment. 1

Do not discontinue or reduce aspirin to "help the hematoma heal." This creates catastrophic thrombotic risk that vastly outweighs local bleeding concerns. 1

Do not rely on hematoma size alone for risk stratification. Even small hematomas can harbor occult pseudoaneurysms detectable only by Doppler ultrasound. 1

Rationale for Gradual Activity Progression

The 2-week timeframe allows adequate healing of the arterial puncture site while the hematoma undergoes organized resorption. 1 Hip flexion during sitting and straining during exercise raise intra-abdominal and femoral pressures, which can stress the healing arterial wall and potentially convert a stable hematoma into a communicating pseudoaneurysm. 1 The combination of antiplatelet therapy and mechanical stress creates additive risk, making conservative activity restriction prudent through week 3. 1

By day 21-28, if the one-month ultrasound confirms complete resolution, full unrestricted activity including exercise may resume. 1