Ulus Travma Acil Cerrahi Derg. 2008; 14(1): 70-72

Delayed 31st day traumatic hemothorax on acenocoumarol for aortic valve replacement

Konstantinos X Siafakas, Efthimios D Avgerinos, Alexandros Papalampros, Theodossios Perdikides
Department Of Thoracic Surgery, Hellenic Airforce Hospital, Athens, Greece

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.

Keywords: Acenocoumarole, blunt trauma; hemothorax; rib fracture/complication.

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Aortik kapak replasmanýna yönelik asenokumarol kullanýmý sýrasýnda 31. günde meydana gelen geç travmatik hemotoraks

Konstantinos X Siafakas, Efthimios D Avgerinos, Alexandros Papalampros, Theodossios Perdikides
Yunan Hava Kuvvetleri Hastanesi, Göðüs Cerrahisi Kliniði, Atina, Yunanistan

Aortik kapak replasmaný sonrasýnda asenokumarol kullanan 48 yaþýnda bir erkek, son 24 saat içinde sol torasik bölgede aðrý, ilerleyici dispne ve giderek kötüleþen tarzda halsizlik geliþmesi nedeniyle acil servise baþvurdu. Hastada, 31 gün önce düþme nedeniyle sol kaburgalarýnda kýrýklar geliþmiþti ve 15 gün önce çekilen toraks grafisinde hemopnömotoraks bulunmuyordu. Hastaneye yatýrýlma sýrasýnda çekilen göðüs filmi sol plevral efüzyon bulunduðunu ortaya koyarken, hastanýn periferik kan hematokrit deðeri %28 ve INR deðeri de 3,57 idi. Plazma transfüzyonundan sonra hastanýn INR deðeri ikiye düþtü, ancak beþ saat sonra kan hematokrit deðeri %22,6 seviyesine indi. Hemotoraks, bir göðüs tüpü yoluyla drene edildi ve daha sonra da kan transfüzyonu gerçekleþtirildi. Asenokumarol geç hemotoraksý baþlatan faktör olmayabilir, ancak kanamanýn artmasýndan sorumlu tutulabilir. Antikoagülan alan ve kaburga kýrýðý bulunan bütün hastalarýn, travma sonrasý 4. haftaya kadar yakýn bir gözetimde tutulmasý önerilir.

Anahtar Kelimeler: Asenokumarol, hemotoraks; kaburga kýrýklarý/ komplikasyon; künt travma.

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