A retrospective study of the management of retro-peritoneal bleeding after percutaneous coronary intervention in the era of combination anti-platelet therapy.

BACKGROUND: Combination anti-platelet therapy is mandatory in patients undergoing percutaneous coronary intervention (PCI) to reduce coronary events and stent thrombosis but increases the risk of bleeding. In particular, the management of retroperitoneal haemorrhage (RPH) after PCI is uncertain and made more complex as multiple anti-platelet agents are given routinely. We audited the outcome of patients who experienced RPH and sought to determine whether operative management was required.
METHODS: We conducted a retrospective observational audit of all patients undergoing PCI at a single institution over a 5-year period.
RESULTS: RPH occurred in 12 patients. Nine patients were managed without surgery. Patients with RPH needed prolonged admissions (mean length of stay 9.5 days), and were transfused with a mean of 4.5 units of packed red cells. Although there were no deaths, one patient had a spinal infarction.
CONCLUSION: Management of RPH may be conservative unless there is ongoing bleeding. RPH has resource implications in terms of transfusions, prolonged length of stay and morbidity.