Manejo perioperatorio y periprocedimiento del tratamiento antitrombótico: documento de consenso de SEC,SEDAR, SEACV,SECTCV, AEC,SECPRE, SEPD,SEGO, SEHH,SETH, SEMERGEN,SEMFYC, SEMG,SEMICYUC, SEMI,SEMES, SEPAR,SENEC, SEO,SEPA, SERVEI,SECOT y AEU

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.Full English text available from: www.revespcardiol.org/en     

腹痛,腹泻,便血,脱发,指甲萎缩,胃肠息肉

患者女,67岁。2个月前始,无明显原因及诱因出现上腹及脐周痛,伴腹胀、纳差,腹泻与便秘交替出现。胃镜检查发现胃粘膜皱襞粗大,呈脑回状,胃体前壁及大弯侧可见弥漫性息肉样粘膜增生、糜烂。大便OB(++)。按“糜烂性胃炎”口服洛赛克、西沙必利等10天,症状无好转。近半月,患者腹痛、腹泻加重,大便呈水样或稀糊状,带大量粘液,每日7～10次。1周前,反复便血3次,每次50～100ml,且头发、眉毛大量脱落,双手、足指(趾)甲进行性萎缩,皮肤干燥,下肢浮肿。家族中无类似疾病患者。该患者有糖尿病史6年。入院查体:T36.5℃,P70次/min,R20次/min,Bp17/8kPa。皮肤粗糙、脱屑,面部及双眼睑轻度浮肿,毛发稀疏。口腔粘膜无溃疡,舌质红,无苔。心肺正常。腹部轻度膨隆,无肠型及蠕动波,全腹轻度压痛,无反跳痛,未扪及肿块,肝脾不大,移动性浊音阴性,肠鸣音活跃。双下肢轻度凹陷性浮肿,内踝以上皮面有较密集的黑褐斑。双手、足指(趾)甲萎缩明显,左手无名指、食指及右手小指、双足小趾甲床裸露。外周血:RBC5.46×     

上腹疼痛,饱胀,纳差,恶心,呕吐

上腹疼痛、饱胀、纳差、恶心、呕吐济南市中心医院（２５００１３）田淑杰张书元盛文化病历摘要患者女，３８岁。反复发作上腹疼痛、饱胀、纳差、恶心呕吐３年，伴明显消瘦１年入院。曾在当地医院行钡餐检查示胃下垂、十二指肠球部变形，经常规治疗后症状减轻。１年后因精...     

腹胀,黄疸,呕血,精神萎靡

腹胀、黄疸、呕血、精神萎靡山东省立医院（２５００２１）石军杨崇美朱菊人病历摘要患者女，３２岁。停经７个月，因纳差、恶心、呕吐１周，尿黄３天于１９９６年１２月１１月入院。入院１周前无明显诱因的出现恶心、呕吐，每日１０余次，多为胃内容物，伴上腹痛、纳差、...     

头痛,发热,恶心,呕吐

病历摘要患者女，３８岁。因头痛、发热伴恶心、呕吐半个月于１９９７年８月１６日入院。半个月前，患者无明显诱因出现持续性全头痛，伴非喷射性恶心呕吐，体温３７～３８℃。查体：Ｔ３７．７℃，Ｐ８０次／ｍｉｎ，Ｒ２０次／ｍｉｎ，Ｂｐ１７／１０ｋＰａ。神志清楚，...     

发热,腰痛,腹痛,血尿

病历摘要患者男,２５岁,教师。患者因发热,咽痛于１９９７年７月１日住入外院,诊断急性扁桃体炎。该院给予静脉滴注青霉素８００万ｕ／ｄ,２ｄ后发热、咽痛缓解,但出现持续性腰痛、腹痛,呈阵发性加剧,伴有肉眼血尿。于１９９７年７月６日晚转来我院就诊。急诊室以尿路感染、尿路结石收入肾内科病房治疗。既住史：平素健康,无结核史。２月前出现尿频、尿急、尿痛等症状。入院体检：Ｔ３７．５°Ｃ,Ｒ２４次／ｍｉｎ,Ｐ１００次／ｍｉｎ,ＢＰ１６／１２ｋＰａ（１２０／９０ｍｍＨｇ）。神志清,急性痛苦病容,周身皮肤、粘膜未见…     

紫绀,憋喘,腹胀,水肿

病历摘要患者女,４６岁。发现心脏杂音４０余年,活动后心慌,气促伴口唇青紫６年多,因出现腹胀、纳差、憋喘伴双下肢水肿２个月而入院。无蹲踞史,无关节炎及结核病史。查体：Ｔ３６８℃,Ｐ９８次／ｍｉｎ,Ｒ２６次／ｍｉｎ,Ｂｐ１２／９ｋＰａ。身高１６３ｃｍ,体重３５ｋｇ。严重消瘦,呈恶病质,口唇紫绀,颈静脉怒张,杵状指（趾）。双肺呼吸音粗。心前区无隆起,未触及震颤,心尖搏动弥散,心界向双侧扩大,胸骨左缘第三、四肋间闻及Ⅱ／６级收缩期杂音,胸骨右缘第五肋间闻及Ⅱ／６级收缩期杂音,均柔和,Ｐ２消失。蛙状腹、…     

腹胀,腹痛,低热,血性腹水

第一次查房主任医师：这次讨论的是位老年患者,以发热、腹水、血沉快为特点,至今未明确诊断。先请简要汇报病历。实习医师：患者男,６５岁,因腹胀、腹痛、纳差、低热２周入院。体检：Ｔ３７．８℃。心肺（－）。腹壁静脉无怒张,腹肌略紧张,有柔韧感,全腹未触及包块...