The aim of this study was to gauge the effectiveness of
thrombin injection after failed manual compression in patients with
false aneurysms receiving full-dose antiplatelet and
heparin therapy. In consecutive patients with failed manual compression
therapy (ultrasound-guided manual compression,
compression bandage, or both),
thrombin was injected under ultrasound guidance. In 23 patients,
thrombin was injected into the
false aneurysm (100-2,000 units; mean, 895 +/- 520 units). All patients were on
aspirin (median dose, 100 mg/day),
clopidogrel (median dose, 75 mg/day), and either
heparin (n = 3) with a partial thromboplastin time (PTT) > 55 sec or weight-adjusted
enoxaparine (0.1 ml per 10 kg; maximum, 1 ml/b.i.d.). Twelve patients had received an i.v. GB IIIb/IIa antagonist 11-72 hr prior to diagnosis of the
aneurysm. The mean width of the
false aneurysms was 20.8 +/- 3.2 mm (range, 8.0-52.0 mm), length 29.7 +/- 32.6 mm (range, 9.0-147 mm), and depth 19 +/- 9.1 mm (range, 5.1-35.5 mm).
Thrombosis after
thrombin injection occurred in 21 patients within seconds. One patient required a second injection the next day, one patient underwent surgery. Overall success rate was 96%. No in-hospital complications occurred. In patients with
false aneurysms and failed compression
therapy under full-dose
aspirin,
clopidogrel, and
heparin, selective
thrombin injection is highly effective and safe.