Moeinipour Aliasghar, Zarifian Ahmadreza, Sheikh Andalibi Mohammad Sobhan, Shamloo Alireza Sepehri, Ahmadabadi Ali, Amouzeshi Ahmad, Hoseinikhah Hamid
Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
Heart Surg Forum. 2015 Dec 22;18(6):E271-4. doi: 10.1532/hsf.1348.
It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement.
We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review.
For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices.
The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).
对于植入心脏假体装置的患者，尤其是心脏瓣膜假体、动脉支架、除颤器和起搏器装置的患者，进行抗凝治疗是常见的做法。当这些患者在机动车事故后遭受多处创伤时，针对这种具有挑战性情况的最佳医疗管理是必不可少的。该策略应包括对所有可能的多器官损伤进行快速诊断，特别关注抗凝治疗，以尽量降低假体装置中血栓栓塞并发症的风险。在本综述中，我们描述了心脏瓣膜置换术后使用抗凝剂的多处创伤患者的最佳医疗管理方法。
我们使用以下术语在电子数据库PubMed/Medline、Scopus、Embase和谷歌学术中进行搜索：抗凝剂、华法林、肝素和多处创伤。此外，还纳入了数据库推荐的类似研究。非英文文章被排除在综述之外。
对于使用抗凝治疗的患者，心脏外科医生、普通外科医生、麻醉师和心脏病专家之间的团队合作至关重要。为了实现最佳医疗管理，该团队成员之间必须进行多次会诊，以便快速诊断所有可能受损的器官，特别关注中枢神经系统、胸部和腹部创伤。采用这种策略时，注意抗凝药物以尽量降低心脏装置中血栓栓塞并发症的风险很重要。
心脏瓣膜置换术后使用抗凝剂的多处创伤患者进行急诊手术时，最佳的抗凝剂是新鲜冰冻血浆（FFP）和凝血酶原复合物浓缩剂（PCC）。
