4. Vascular Trauma

Aspirin for Heart Attack Prevention: Myth vs. Reality

Something that my patients ask me a lot is if it is okay or beneficial to take a daily aspirin to prevent heart attacks and strengthen the circulatory system. The truth is that even though some people indicate this therapy as prevention, it is not for everyone. Aspirin is a drug that prevents blood from clotting; my patients say it makes the blood “more liquid,” and in part, it does. This anticoagulant effect works in the case of ischemic pathology, when there are thrombi that have formed inside the blood vessels or the heart. However, we must remember that not all circulatory pathologies are ischemic; there are also hemorrhagic ones, for example, hemorrhagic stroke. In these cases, aspirin seriously worsens the problem since it takes longer for the blood to reach the coagulation state. If you suspect a myocardial infarction, the first thing you should do is call 911, without postponing it. You should try to remember as much information as possible, such as the time the pain started, and places where it is most intense, pain in the mouth of the stomach, among others, as well as the treatment you are taking, if any, and not to take any medication unless the responder suggests it.

Although vascular trauma is not the most common, I can say that it is seen with relative frequency. Especially with the rate of insecurity in my country and the number of wounded, especially from firearms, I think Venezuelan surgeons have quite a lot of experience in dealing with vascular trauma. The first time I saw one was when working as a general practitioner at a clinic where a lady came to the emergency room with a small wrist injury she got while peeling a pumpkin. The wound wouldn’t stop bleeding and had a small lump just below it. The surgeon on duty diagnosed a vascular injury that, when explored, was a small cut in the radial artery. Accidents such as stabbing, shooting, violence, internal abdominal trauma from collision, displaced fractures, and dislocated joints are common causes of vascular injury. Vascular wounds can be arterial, venous, or capillary, with venous wounds causing heavy bleeding of dark red blood. Arterial wounds, on the other hand, have pulsating bleeding, and the blood is bright red. Bleeding from capillary damage is slight and self-limiting. The most important thing when faced with a vascular injury is to stop the bleeding. When compression is applied to a blood vessel, the coagulation mechanism is activated. In the case of venous injuries, doing moderate compression can partially stop the bleeding while waiting for emergency personnel. Arterial bleeding has a much higher pressure, so this type of bleeding is more difficult to stop. Pressure should be applied firmly against a bony surface.