SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Evaluate the risk factors, management and outcomes for RSH
METHODS: RSH cases were identified from the CT reports from MARS laboratory data system from 1/2005 to 6/2009. Selected patient charts were reviewed for demographic data and risk factors, management and outcomes. Descriptive statistics used to analyze the risk factors and outcomes. Mortality evaluated using logistic regression analysis.
RESULTS: CT diagnosis of RSH identified 146 reports. 31 patients excluded because of inadequate documentation. Of the 115 patients evaluated; 73(63.5%) females, 12 (10.4%) African American, mean age 63.3 years (SD 16.9, range 18.9-87.6). 28 (27.7%) were obese. 67 (58.3%) patients had CKD of stage >=3 and 53 (47% %) on chronic anticoagulation. During hospitalization 69 (61%) patients received treatment doses of AC, 19 (17 %) prophylactic doses while 23% did not receive AC. 34 (42.11%) patients were on steroids or immunosuppressant medications. 96 patients(83.5%) had abdominal surgery/femoral puncture or SQ abdominal injections. The presenting symptoms of RSH were pain, drop in hematocrit, hypotension, or no symptoms. RSH treatment was observation in 44 (38%), medical in 57 (49.57%) and surgical in 14(12.2%) patients. There were 25 deaths (21.7%); RSH was a contributing factor in only one patient. Mortality was associated with CKD stage >=3 (OR 2.7, p=0.047, 95% CI 1.01-7.58) and if RSH required treatment (medical or surgical) (OR 3.01, p=0.004, 95%CI 1.44-6.32).
CONCLUSIONS: Our exploratory study highlights the importance of RSH as a bleeding complication. Patients with CKD stage >=3 and those who required medical or surgical management of RSH may be vulnerable to adverse outcomes. A high percentage of patients received medications affecting platelets, and had abdominal trauma. These risk factors and anticoagulation may contribute to the occurrence of RSH. The study findings warrant further exploration.
CLINICAL IMPLICATIONS: Study results inform the additional risk factors for RSH which are not commonly known and considered. Increased awareness among the caregivers will make patient care safer and reduce incidence of RSH.
DISCLOSURE: The following authors have nothing to disclose: Heena Sheth, Jeannine DiNElla, Cheryl Janov, Roy Smith, Hoda Kaldas
No Product/Research Disclosure InformationUniversity of Pittsburgh, Pittsburgh, PA