Interesting case of expanding hematoma



77 y.o F PMHx CAD, AF on Eliquis presents with R thigh hematoma. 

  • Cardiac cath 10 days prior (access through R femoral)
  • Also states fall few days prior, hitting R leg against book shelf
  • Progressively worsening x6 days



BP 104/53  | Pulse 70 | Temp 97.9 °F | Resp 18  | SpO2 100%  

  • R thigh with large bruise extending from knee to hip, with extension to RLQ abdomen.
  • Baseball sized area of swelling medial thigh with small bullae. 
  • Thigh and lower leg compartments soft. 
  • Motor/sensory intact. 
  • Palpable distal pulses. 
  • R femoral signal on doppler.  



  • Pseudoaneurysm (recent cath), expanding hematoma (recent trauma), active arterial bleed, acute blood loss anemia (in setting of AC)



  • Labs: CBC, BMP, coags, type & screen
  • Imaging: US groin pseu protocol, CTA RLE



  • HGB 6.4 from 9.6 five days prior
  • US: Evolving R groin subcutaneous hematoma, 12.6 cm. No pseudoaneurysm or AV fistula.
  • CTA: large hematoma with small active extravasation from inferior aspect of hematoma
  • 1U pRBCs, Kcentra (later also given plasma)
  • IR - successful coil embolization



  •  Cardiac cath complications - femoral artery pseudoaneurysm → may require surgical intervention
  • Reversing NOACs (‘xabans’) - Eliquis, Xarelto
    • Andexanet alfa (Andexxa): preferred reversal agent for patients with life threatening CNS, epidural, or ocular bleed or acute hemorrhage 
    • 4F PCC aka Kcentra: bleeding from other sites
      • Contains Factors II, VII, IX, X, proteins C and S
    • Second line: FFP
  • Any concern for arterial bleeding or compromise requires CTA