Symptoms associated with hematoma caused by radial artery injury successfully treated with jidabokuippo

Dear Editor Jidabokuippo (JDI) is a herbal mixture used in Japan to alleviate contusion-induced swelling and pain caused by bruises and sprains. It has also been applied to various traumas and cellulitis [1]. There have been a few reports of JDI being applied for bleeding and pain after venipuncture; however, there are few reports on the symptoms after arterial puncture [2,3]. We encountered a case in which JDI was useful for subcutaneous hematoma, swelling, and pain due to catheterization-induced radial artery injury. A 59-yearold man with a history of hypertension, acute myocardial infarction, and chronic kidney disease, experienced chest tightness one week before admission. As the patient’s chest tightness increased, he was admitted for suspected exertional angina pectoris and underwent coronary angiography. A percutaneous coronary intervention (PCI) sheath was inserted through the left radial artery. The patient was administered 200 mg of oral aspirin and 12,000 units of intravenous heparin during the PCI procedure. Immediately after PCI sheath insertion, blunt pain in the forearm developed, and swelling was noted (The Numerical Rating Scale [NRS] was 3/10). After the PCI procedure, compression hemostasis was intensified because of increased swelling in the forearm. Ultrasonography did not reveal any obvious hemorrhagic areas. After the procedure, hemoglobin and hematocrit levels decreased from 15.2 g/dl to 11.9 g/dl and from 46.0% to 35.7%, respectively. Nonetheless, the patient’s vital signs were stable, and he was discharged one day after the procedure. The subcutaneous hemorrhage and swelling in the left upper limb increased, and the pain in the forearm worsened to 8/10 on the NRS. Dorsiflexion of the wrist joint and extension of the elbow joint were no longer possible because of pain and swelling. Therefore, 7.5 g/day of JDI (extract TJ-89, Tsumura & Co., Tokyo, Japan) was administered (Figure 1a). Four days after the procedure, JDI was discontinued because the swelling and pain were reduced (NRS 5/10) (Figure 1b). However, a