The inadvertent administration of anticoagulants to ED patients ultimately diagnosed with thoracic aortic dissection

Abstract

Objectives Aortic dissection (AD) may present similarly to acute coronary syndrome or pulmonary embolus; however, anticoagulation may be detrimental to patients with AD. Methods Clinical data were abstracted from medical records of emergency department (ED) patients with nontraumatic AD. Patients administered with anticoagulants were compared with non–anticoagulated patients with regard to presenting symptoms, chest radiograph and electrocardiogram (ECG) findings, and outcome. Results A total of 44 ED patients with nontraumatic AD was identified over a 4-year period; anticoagulants were administered to 9 (21%). Anticoagulated patients had a higher incidence of chest pain without back pain (78% vs 23%; P = .002) and ST elevations or depressions on ECG (89% vs 6%; P < .001) and were less likely to have a widened mediastinum on chest radiograph (0% vs 67%; P < .001). Two ED anticoagulated patients died, one required a second surgery for bleeding complications, and another suffered a stroke after reversal of anticoagulation. Conclusions There is a clinically significant incidence of anticoagulation administration to ED patients ultimately diagnosed with AD, especially in the presence of ambiguous ECG and radiographic findings.