伤害前的抗凝剂是否使胸腔管变得不那么安全? 一个全国性的回顾性分析
Brendan Tarantino1, Myles Wood1, David Hancock1
1Weill Cornell Medicine, United States of America.
The American journal of emergency medicine
|May 24, 2024
概括
创伤前的抗凝治疗和胸腔管置入 (胸膜切除术) 独立地增加创伤患者的死亡率和住院时间. 然而,这些因素没有相互作用,这意味着它们的综合风险是附加的,而不是乘数的.
科学领域:
- 创伤外科 手术 创伤外科
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在老年人群中,口服抗凝剂的使用正在增加,人们越来越担心在侵袭性手术 (如胸腔管置入术) 期间出现出血风险.
- 肺胸部和血胸部的发病率正在增加,通常通过CT成像检测出来,需要对抗凝血患者的治疗风险进行评估.
- 在接受抗凝剂治疗的患者中,与胸腔切除术相关的具体风险尚未明确.
研究的目的:
- 调查是否受伤前的抗凝剂影响了在严重的胸部创伤后需要管胸切除术的相对风险.
- 评估抗凝剂和胸腔切除术对患者结局的独立和联合影响.
主要方法:
- 这是一项回顾性队列研究,利用2019年美国外科医生学院创伤质量计划 (ACS-TQP) 数据库.
- 包括成年患者 (≥18岁) 患有创伤性血胸,肺胸或血肺胸,不包括缺少数据或没有生命迹象的患者.
- 患者根据受伤前的抗凝血状态和胸腔管的位置进行了分层;死亡率和住院时间 (LOS) 分别是主要和次要结局,用于分析的是后勤和标准回归.
主要成果:
- 这项研究分析了72385名患者,其中4250名受伤前服用抗凝剂.
- 伤害前的抗凝剂和胸腔切除术都与增加的死亡率和LOS独立相关.
- 一个无意义的相互作用术语表明,抗凝血剂和胸腔切除术对死亡率和LOS的联合影响是附加的,而不是协同的.
结论:
- 在成人胸部创伤患者中,损伤前的抗凝剂和胸腔切除被确定为死亡率和长期住院LOS的独立风险因素.
- 该研究发现,抗凝血药和胸腔切除术之间没有显著的相互作用,这表明它们的风险是累积的.
- 建议进行进一步的研究,以完善用于治疗需要胸腔切除的胸部创伤的抗凝药患者的临床指南.
相关概念视频
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
681
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
681
01:26Flail Chest-II
165
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
165
01:26Endoscopic Studies II: Thoracocentesis
250
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
250
01:20Extrinsic and Intrinsic Pathways of Hemostasis
7.2K
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
7.2K