Thrombin injection for treatment of false aneurysms after failed compression therapy in patients on full-dose antiplatelet and heparin therapy

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. Cathet Cardiovasc Intervent 2003;58:505–509. © 2003 Wiley‐Liss, Inc.