Emergency Department Azienda Ospedaliero-Universitaria Pisana, Pisa.
Emergency Department; Azienda Ospedaliero-Universitaria Pisana, Pisa University Hospital, Italy.
Monaldi Arch Chest Dis. 2020 Jun 12;90(2). doi: 10.4081/monaldi.2020.1262.
The number of patients treated with direct oral anticoagulants is increasing worldwide. Although bleeding complications associated with direct oral anticoagulants are lower than those associated with vitamin K antagonists, the increased number of patients treated with these anticoagulants suggests that a higher absolute number of patients are at risk. Tube thoracostomy is an invasive procedure with a high risk of bleeding. To date, among direct oral anticoagulants, only dabigatran has a well-studied antidote to reverse its effects during emergency procedure or surgery. This report describes a case in which emergency placement of a tube thoracostomy, in a patient with type 2 respiratory failure due to left tension pneumothorax and receiving the anticoagulant rivaroxaban, in the pharmacokinetics phase with greater anticoagulant effect, did not result in bleeding greater than that typically encountered during such interventions. The procedure ended successfully with no acute complications.
直接口服抗凝剂治疗的患者数量正在全球范围内增加。尽管直接口服抗凝剂相关的出血并发症低于维生素 K 拮抗剂相关的出血并发症，但接受这些抗凝剂治疗的患者数量增加表明，有更高比例的绝对数量的患者面临风险。胸腔引流术是一种具有高出血风险的侵入性操作。迄今为止，在直接口服抗凝剂中，只有达比加群有一个研究充分的解毒剂，可以在紧急手术或手术期间逆转其作用。本报告描述了一例患者，该患者因左侧张力性气胸导致 2 型呼吸衰竭，正在接受抗凝剂利伐沙班治疗，处于药代动力学阶段，抗凝效果更强，行胸腔引流术并未导致比此类干预中通常遇到的更多的出血。该操作成功结束，没有出现急性并发症。
