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[JAMA诊断检查解读]:口服抗凝药物患者的凝血结果解读(问题)
2018年10月12日 临床话题, 模拟诊室 暂无评论

JAMA Diagnostic Test Interpretation

September 14, 2018

Coagulation Test Interpretation in a Patient Taking Direct Oral Anticoagulant Therapy

Michelle Sholzberg, Yan Xu

JAMA. 2018;320(14):1485-1486. doi:10.1001/jama.2018.13998

Case 病例

74-year-old man presented with spontaneous, acute onset of confusion and headache. He had no preceding head trauma or falls. He had a history of atrial fibrillation with an annual stroke risk of 2.9% (based on points accrued for hypertension and age ≥65 years using the CHA2DS2-VASc score1). He was being treated with rivaroxaban, 20 mg daily. He took his last dose 14 hours prior to presentation. Other medications included ramipril and rosuvastatin.

一名74岁男性患者因急性起病的自发性意识模糊及头痛就诊。患者无颅脑外伤或摔倒病史。患者有房颤病史,年卒中风险为2.9%(根据CHA2DS2-VASc评分,高血压及年龄 ≥65岁)。患者服用利伐沙班20 mg qd,最后一次服药在就诊前14小时。其他药物包括雷米普利(ramipril)和瑞舒伐他汀(rosuvastatin)。

On physical examination, the patient’s blood pressure was 157/96 mm Hg, heart rate was 72/min, and Glasgow Coma Scale score was 14 (range, 3-15 with 15 indicating best neurological status). Head computed tomogram (CT) showed a 2.5-cm left-sided acute subdural hematoma with mass effect. He required urgent surgical evacuation and the neurosurgical team requested advice regarding his perioperative bleeding risk prior to surgery. Laboratory test results are shown in the Table.

体格检查发现,患者血压157/96 mm Hg,心率72/min,格拉斯哥昏迷评分14分(范围,3-15,15分提示最佳神经系统状态)。头颅CT显示左侧2.5-cm急性硬膜下血肿伴占位效应。患者急需手术治疗,神经外科医生要求术前评估围手术期出血风险。实验室检查结果见下表。

Table.

 

How Do You Interpret These Results? 你如何解读上述结果

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