Nasty Bruising 5 Days after CT scan with Contrast

[BobTex]

Originally Posted by Priya36

Patient stopped taking aspirin 5 days prior to CT scan with and without contrast

The therapeutic anticoagulation effects of aspirin last 5-7 days. The site looks fine to me. I'm a retired neuro trauma ICU RN with 30 years of patient care experience. I was never administrative other than 12 years charging the unit .

Also you may be possibly searching to see if the contrast may have cause excessive bleeding at the site and IMO the answer is no.

Please keep in mind that everyone's body is unique so in healthcare there are no 100% absolutes. Like you asking how long the effects of the ASA (aspirin) lasts . . . my 5-7 day answer was the accepted general rule. Lots of things can affect the coagulation cascade such as a poorly functioning liver.

[Medical Lab Guy]

Since Bob posted his reply it got me thinking again concerning anticoagulants and more appropriately clinically acquired coagulation defects. There is one high incident acquired defect in people with severe aortic stenosis (AS). It is called acquired Von Willebrand Syndrome. This can cause some bleeding more than usual. So according to the study below about 67% of patients will have this defect with severe aortic stenosis. Not all will have massive blood loss but a significant portion of people with AS will have some bleeding slightly more than usual.


"Unexpectedly High Prevalence of Acquired von Willebrand Syndrome in Patients with Severe Aortic Stenosis as Evaluated with a Novel Large Multimer Index>"

https://pubmed.ncbi.nlm.nih.gov/26269004/

Because it is common most doctors are aware of this effect and know how to treat it. When confronted with bleeding that is unaccounted for then cryoprecipitate transfusions are a common practice usually during or after open-heart surgery.

I agree with Bob that the bleeding is not that excessive in the picture shown but until the aortic stenosis is corrected then expect to see a few more bruises to show up after procedures like blood drawing or arterial entries.

[Priya36]

Originally Posted by BobTex

The therapeutic anticoagulation effects of aspirin last 5-7 days. The site looks fine to me. I'm a retired neuro trauma ICU RN with 30 years of patient care experience. I was never administrative other than 12 years charging the unit .

Also you may be possibly searching to see if the contrast may have cause excessive bleeding at the site and IMO the answer is no.

Please keep in mind that everyone's body is unique so in healthcare there are no 100% absolutes. Like you asking how long the effects of the ASA (aspirin) lasts . . . my 5-7 day answer was the accepted general rule. Lots of things can affect the coagulation cascade such as a poorly functioning liver.

I salute Nurses, especially in trauma unit.

Will check if contrast had any effect

Patient has extremely sensitive and thin skin.

Thank you for all the info.

[Priya36]

Originally Posted by Medical Lab Guy

Since Bob posted his reply it got me thinking again concerning anticoagulants and more appropriately clinically acquired coagulation defects. There is one high incident acquired defect in people with severe aortic stenosis (AS). It is called acquired Von Willebrand Syndrome. This can cause some bleeding more than usual. So according to the study below about 67% of patients will have this defect with severe aortic stenosis. Not all will have massive blood loss but a significant portion of people with AS will have some bleeding slightly more than usual.


"Unexpectedly High Prevalence of Acquired von Willebrand Syndrome in Patients with Severe Aortic Stenosis as Evaluated with a Novel Large Multimer Index>"

https://pubmed.ncbi.nlm.nih.gov/26269004/

Because it is common most doctors are aware of this effect and know how to treat it. When confronted with bleeding that is unaccounted for then cryoprecipitate transfusions are a common practice usually during or after open-heart surgery.

I agree with Bob that the bleeding is not that excessive in the picture shown but until the aortic stenosis is corrected then expect to see a few more bruises to show up after procedures like blood drawing or arterial entries.

Yes Patient bleeds more than usual. Didn’t realize it can be due to severe aortic stenosis.

[Priya36]

Originally Posted by Parnassia

Why is he taking baby aspirin? His prescribing MD should be weighing the cost/benefit of stopping the aspirin and how far in advance is safe to do so.

He was getting chest pains and dizziness was scared of heart attack. Heart issue is being addressed (Patient hopes to get the TAVR soon)

[ebbe]

I would say to check with the MD about this to make sure it isn't related to a low platelet issue. Simple bloodwork can check the count to see what's happening. Whatever it is, I would let the MD know just to be safe.

[Priya36]

Ok will check low platelet issue