Dergiler / Ulusal Travma ve Acil Cerrahi Dergisi / 2008 / Cilt: 14 - Sayı: 1
Delayed 31st day traumatic hemothorax on acenocoumarol for aortic valve replacement
- Sayfa
- 70–72
- DOI
- —
Özet
Aortik kapak replasman› sonras›nda asenokumarol kullanan 48 yafl›nda bir erkek, son 24 saat içinde sol torasik bölgede a¤r›, ilerleyici dispne ve giderek kötüleflen tarzda halsizlik geliflmesi nedeniyle acil servise baflvurdu. Hastada, 31 gün önce düflme nedeniyle sol kaburgalar› nda k›r›klar geliflmiflti ve 15 gün önce çekilen toraks grafisinde hemopnömotoraks bulunmuyordu. Hastaneye yat›r›lma s›ras›nda çekilen gö¤üs filmi sol plevral efüzyon bulundu¤unu ortaya koyarken, hastan›n periferik kan hematokrit de¤eri %28 ve INR de¤eri de 3,57 idi. Plazma transfüzyonundan sonra hastan›n INR de¤eri i k iye düfltü, ancak befl saat sonra kan hematokrit de¤eri %22,6 seviyesine i n d i. H e m otoraks, bir gö¤üs tüpü yoluyla drene edildi ve daha sonra da kan transfüzyonu gerçeklefltirildi. Asenokumarol geç hemotoraks› bafllatan faktör olmayabilir, ancak kanaman›n artmas›ndan sorumlu tutulabilir. Antikoagülan alan ve kaburga k›r›¤› bulunan bütün hastalar›n, travma sonras› 4. haftaya kadar yak›n bir gözetimde tutulmas› öneril i r.
Abstract
A 48-year-old man, on acenocoumarol due to past aortic valve replacement, was referred to our emergency department for left thoracic pain, progressive dyspnea and fatigue gradually worsening over the past 24 hours. Thirty-one days ago he had suffered from left rib fractures due to a fall, while 15 days ago his regular follow-up chest X-ray was negative for hemopneumothorax. On admission, chest X-ray revealed left pleural effusion, while his peripheral blood hematocrit was 28% and the INR 3.57. Following plasma transfusion his INR recovered to two, but five hours later his blood hematocrit dropped to 22.6%. The hemothorax was then drained by a chest tube and followed by blood transfusion. Acenocoumarol might not have been the initiating factor of delayed hemothorax, but could be blamed for the exacerbation of bleeding. It is recommended that all patients with rib fractures, receiving anticoagulants should have a close surveillance until the 4th week post-injury.