The American journal of emergency medicine · 2005
The inadvertent administration of anticoagulants to ED patients ultimately diagnosed with thoracic aortic dissection.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Davis Daniel P, Grossman Karun, Kiggins Danielle C, Vilke Gary M, Chan Theodore C
Аннотация
OBJECTIVES: Aortic dissection (AD) may present similarly to acute coronary syndrome or pulmonary embolus; however, anticoagulation may be detrimental to patients with AD.
METHODS: Clinical data were abstracted from medical records of emergency department (ED) patients with nontraumatic AD. Patients administered with anticoagulants were compared with non-anticoagulated patients with regard to presenting symptoms, chest radiograph and electrocardiogram (ECG) findings, and outcome.
RESULTS: A total of 44 ED patients with nontraumatic AD was identified over a 4-year period; anticoagulants were administered to 9 (21%). Anticoagulated patients had a higher incidence of chest pain without back pain (78% vs 23%; P = .002) and ST elevations or depressions on ECG (89% vs 6%; P < .001) and were less likely to have a widened mediastinum on chest radiograph (0% vs 67%; P < .001). Two ED anticoagulated patients died, one required a second surgery for bleeding complications, and another suffered a stroke after reversal of anticoagulation.
CONCLUSIONS: There is a clinically significant incidence of anticoagulation administration to ED patients ultimately diagnosed with AD, especially in the presence of ambiguous ECG and radiographic findings.
METHODS: Clinical data were abstracted from medical records of emergency department (ED) patients with nontraumatic AD. Patients administered with anticoagulants were compared with non-anticoagulated patients with regard to presenting symptoms, chest radiograph and electrocardiogram (ECG) findings, and outcome.
RESULTS: A total of 44 ED patients with nontraumatic AD was identified over a 4-year period; anticoagulants were administered to 9 (21%). Anticoagulated patients had a higher incidence of chest pain without back pain (78% vs 23%; P = .002) and ST elevations or depressions on ECG (89% vs 6%; P < .001) and were less likely to have a widened mediastinum on chest radiograph (0% vs 67%; P < .001). Two ED anticoagulated patients died, one required a second surgery for bleeding complications, and another suffered a stroke after reversal of anticoagulation.
CONCLUSIONS: There is a clinically significant incidence of anticoagulation administration to ED patients ultimately diagnosed with AD, especially in the presence of ambiguous ECG and radiographic findings.