Zschaler Silke, Schmidt Gerard, Kukucka Marian, Syrmas Georg, Zaschke Lisa, Kurz Stephan Dominik
Institute for Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Cardiovasc Diagn Ther. 2018 Dec;8(6):805-810. doi: 10.21037/cdt.2018.10.13.
Inadvertent emergency anticoagulation in patients with acute type A aortic dissection (ATAAD) has been sparsely reported. There are case reports bringing this potential critical incident to attention, however, little is known about the number of undetected and unreported cases. We approach this issue based on a case report of inadvertent emergency anticoagulation in ATAAD and attempt to shed light on aspects that may have contributed to the critical incident: The challenge of distinguishing an ATAAD from an acute coronary syndrome (ACS) and the potential underestimation of incidents of ATAAD. We also discuss errors and biases in medical decision making, and provide suggestions that may help raise awareness of how ATAAD can be mimicking ACS in clinical practice.
急性A型主动脉夹层（ATAAD）患者的意外紧急抗凝情况鲜有报道。虽有病例报告引起了人们对这一潜在严重事件的关注，但对于未被发现和未报告的病例数量却知之甚少。我们基于一例ATAAD意外紧急抗凝的病例报告来探讨这个问题，并试图阐明可能导致这一严重事件的因素：区分ATAAD与急性冠状动脉综合征（ACS）的挑战以及ATAAD事件可能被低估的情况。我们还讨论了医疗决策中的错误和偏差，并提出了一些建议，可能有助于提高人们对ATAAD在临床实践中如何模仿ACS的认识。
