Discussion
bleeding, hypercoagulation, shock, ischemia, sepsis, hypertension, thromboembolic occlusive, diabetes
HYPOALBUMINEMIA, BLEEDING, HYPERCOAGULATION, CORONARY THROMBOSIS, DIABETES MELLITUS, INTESTINAL GANGRENE, AMI, EVENTS, ISCHEMIA, GASTROINTESTINAL BLEEDING, METABOLIC ACIDOSIS, DIABETES, SHOCK, CRITICAL ILLNESS, SEPSIS, MYOCARDIAL INFARCTION, GROUP B, INTRACRANIAL HEMORRHAGE, EVENT, HEPARIN INDUCED THROMBOCYTOPENIA, HYPERTENSION
Intestinal gangrene is a severe event with a poor prognosis in patients with AMI [LMWHs have more effective anti-Xa activity than anti-IIa activity, a more predictable anticoagulant response, and a lower incidence of heparin induced thrombocytopenia [In patients with sepsis, hypercoagulation is induced by impairing both the protein C and antithrombin systems [During the period of intensive care, anticoagulant therapy with heparin should be initiated to prevent the progression of the thromboembolic occlusive process within the intestinal arteries [After a short period of critical illness, enteral antiplatelet or anticoagulant therapy is suggested to avoid recurrent ischemia events. Patients with hypertension or diabetes are at high risk of coronary thrombosis and should be treated by antiplatelet therapy [The risk factors for mortality include advanced age (more than 70 years), diabetes mellitus, use of digoxin, delayed surgery, shock status, metabolic acidosis, hypoalbuminemia, recent myocardial infarction, previous cardiac surgery, and colonic involvement [The control of confounding factors is difficult because these patients underwent critical emergent surgery, and had highly different medical histories and preoperative conditions. The patient number is also small because of the low incidence in the eastern world. A major limitation in this study was the dosage of anticoagulant. Due to the retrospective method employed in this study, dosage control was not achievable. The doses chosen by the physician might have been influenced by the patients’ serum creatinine levels, blood platelet counts, INR of PT, and perioperative bleeding events. Two patients with postoperative severe bleeding events, namely, intracranial hemorrhage and gastrointestinal bleeding, were in Group A. Another study limitation involved the periods of parenteral anticoagulant administration and the shifting to enteral antiplatelet/anticoagulant therapy. The period of enoxaparin use was between 1 and 32 days. In Group B, 8 patients had a short period of use (less than 3 days), and in 5 of these cases, this brevity was due to mortality within 3 days after surgery. It was not possible to reach a definite conclusion regarding the optimal beneficial dosage and period based on our research, and thus further study is necessary to shed light on this issue.The appropriate clinical scenario may indicate that patients experience a critical period with unavailable enteral medication after emergent small bowel surgery. During this period, parenteral anticoagulants can be used for bridging treatment. While bowel movement redevelops, oral antiplatelet treatments can be initiated for long-term use.