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

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. (C) 2005 Elsevier Inc. All rights reserved.