1), First regarding anticoagulation

In general it is very debatable whether heparin or warfarin is needed for post-osteosurgery patients.

In china, anticoagulation was not given to any post spinal surgery patients,because of the severe consequence of bleeding. In 2009, 北医三院 did a
retrospective investigation for near 12,000 spinal surgery patients of last 15 years, they found 0.4% of them had signs and symptoms of pumonary embolism, of which 50% died (The authors also claim they may underestimate the morbidity and mortality). In USA, 58% of spinal surgeons do not give any anti-coagulation medication to their patients. The question would be what's the chance of post-op bleeding if anti-coagulation medication is given, no doubt it will increase.

In particular for this patient, she has been taking asprin for many years. Asprin irreversibly inhibits the platelet function. The half-life of platelet is about 5 days. Therefore, the surgeon has righteous reasons to
concern bleeding post-surgically.

Therefore, there is NO logic to give anticoagulation medications for this patient.

2), Regarding the heart and liver rupture (心肝脾破裂)

这要有点专业的医疗知识再想想就能明白. 由于病人双肺动脉栓塞, 右心室里的血压不出去, 外周动脉里血容量巨减-->肾上腺素和去甲肾上腺素释放-->心肌收缩加强-->右心室压大大升高, 加上从主动脉干分出的冠状动脉血巨减--->心肌缺血坏死. 这两样加在一起, 右心室就破了(事实上开胸时证明是右室破了).

为啥肝脾也破了? 这是因为巨大血栓后用尽了身体里的血小板, 凝血因子和胶原. 全身血处于极度低凝状态, 加上肝脾静脉压上升, 肝脾又是血窦器官, 所以很容易破裂出血, 除了肝脾, 病人的肠道也可能出血.

肋骨断了很可能由心肺急救按压时引起的, 这个时有发生,再说后来还开胸取栓了.