According to this study:
* Cold therapy consistently reduced hematoma size more after three hours than did compression therapy.
* Patients found cold packs more comfortable than sandbags.
Percutaneous coronary intervention is considered routine today, but some complications do occur, chief among them being the development of a hematoma at the site of femoral vessel entry. A standard intervention when this occurs is compression with a sandbag, but little scientific evidence supports the efficacy of this approach. It is known that low temperature causes vasoconstriction, and King and colleagues decided to investigate whether triggering local vasoconstriction by applying cold packs would be more effective and better tolerated than sandbags for treating femoral hematomas caused by coronary angiography.
Patients were eligible for the study if they were older than 18 years of age, developed a femoral hematoma of greater than 35 cm2 within two hours of coronary angiography, and were able to give consent. Exclusion criteria included having a history or presence of hematologic disorders, an abnormal international normalized ratio, or an intolerance to compression or cold therapy; use of a sheath larger than 8 F during the procedure; and having the hematoma upon returning to the ward after the procedure.
Fifty participants were randomly assigned to receive either compression therapy or cold therapy. In order to ensure that the therapeutic effect was a result of vasoconstriction and not compression, the cold packs weighed only 365 g while sandbags weighed 2 kg. A baseline measurement of the hematoma was performed and assessments were repeated every 30 minutes for three hours. Patient and staff satisfaction questionnaires were completed, as well.
Cold packs resulted in a statistically significantly greater rate of improvement in hematomas compared with sandbags. Though both interventions reduced the size of hematomas, cold therapy caused consistently greater reductions in size over three hours. Cold therapy was also reported by patients to be more comfortable and by staff to be the preferred method.
Limitations noted by the authors included the small sample size and the additional effort required for cold packs, which needed to be changed every 30 minutes. Possible confounding variables such as differing drug regimens, percutaneous coronary intervention techniques, and methods of closure were not controlled for.
In conclusion King and colleagues stated that cold-pack therapy "has [the] potential to improve clinical outcome[s]" in patients with femoral hematoma secondary to percutaneous coronary intervention and that large, multicenter studies are needed to further evaluate the technique. In future studies imaging techniques such as ultrasound may be helpful in assessing changes in hematomas.
KR