Arthur A. Keresztesi, Gabriela Asofie and Harald Jung
In posttraumatic coronary dissection, a small intimal tear occurs due to the sudden compression of the thoracic wall during the chest trauma, this being sometimes fatal. We present the case of a 56-year-old truck driver with chest trauma after a car crash. The 12-lead ECG showed signs suggestive of an acute anterior myocardial infarction, and the coronary angiography confirmed an arterial dissection of the left anterior descending coronary artery. A stent was inserted the same day, and the patient was treated accordingly. He survived for a total of three days. The autopsy and histological examination confirmed the MI and the coronary dissection. The chest trauma was linked to the patient’s death. The literature review reveals 46 cases in which the most frequent cause of chest trauma was a car or motorcycle accident; also, young male subjects were more frequently involved. Stent placement was the main course of treatment, and a delay in the onset of symptoms was also frequent.
Ionela Silivastru Cozlea, Arthur-Atilla Keresztesi, Gabriela Asofie Keresztesi, Daniel Cozlea and Daniela Ecaterina Dobru
The objective of the current study is to evaluate the complication rates (embolic and hemorrhagic events) in deep venous thrombosis (DVT) patients on different types of oral anticoagulation therapy (OAC): direct oral anticoagulant therapy and vitamin K antagonist therapy.
Methods: A number of 62 DVT patients were included and divided in two groups, depending on the type of oral anticoagulation therapy administered. The first group was composed of patients treated with direct oral anticoagulant treatment (Dabigatran, Rivaroxaban) and the second group was composed of patients treated with vitamin K antagonist (Acenocumarol). General data, including BMI and comorbidities were noted. Embolic and hemorrhagic events were noticed.
Results: in the first group of patients (DOAC therapy), a number of 34 patients were included (14 of them with BMI higher than 25 kg/m2 and 14 with concomitant atrial fibrillation), while the second group comprised of 28 patients treated with VKA (21 of them with a high BMI and only 3 of them with atrial fibrillation). After a mean period of 36 months of anticoagulant therapy, complications were present in 17 patients, hematuria (8 episodes) and pulmonary embolism (4 cases) were the most frequent, with no difference regarding the treatment applied.
Conclusion: No statistically significant difference was encountered regarding embolic and hemorrhagic event rates in our deep vein thrombosis patients.
Silivastru (Cozlea) Ionela, Cozlea Daniel Laurentiu, Keresztesi Arthur Attila, Asofie Gabriela, Cozlea Laurentiu, Oltean Galafteon and Dobru Daniela
Introduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score.
Material and method. We conducted a retrospective observational study on 144 patients with nonvalvular atrial fibrillation, admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș with a prospectiv follow-up at 6 months.
Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc score and the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone and were questioned regarding their state of health, the existence of hospitalizations in the last 6 months, the international normalized ratio (INR) value, the existence of hemorrhagic or thromboembolic events.
Results. The group of patients was composed of 70 female and 74 male with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke.
Hemorrhagic events were encountered in 19 patients (13.19%) and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding.
Conclusions. The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients.