Coronary interventions in patients with bleeding and bleeding tendency

作者: Thach Nguyen , Lan Nguyen Thach Nguyen , Lan Nguyen

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摘要: In general, percutaneous coronary intervention (PCI) is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the need full anticoagulation counter any thrombotic formation caused by introduction manipulation of devices vascular system. The who currently may not tolerate short term anticoagulant effect. have annoying prolonged bleeds especially at surgical or access site while on long antiplatelet drugs such as clopidogrel aspirin (ASA). These critical situation acute myocardial infarction (AMI) unstable angina undergo PCI, spite fact operators difficulty predicting risk controlling further before PCI. Any whose cannot be controlled after should they will succumb from hemorrhagic shock. listed Table 1. There many options for reperfusion infarctrelated artery (IRA) AMI bleeding. differ complement each other. Their benefits risks, advantages disadvantages presented discussed (Table 2). Angioplasty alone without stenting diathesis needed However, if mortality higher than complications then patient transluminal angioplasty (PTCA) IRA. risks PTCA highlighted case study below. Case study: recurrent gastro-intestinal An elderly was admitted chest pain mild hematemesis. electrocardiogram (ECG) showed ST segment elevation. gastroenterologist refused do gastroscopy ongoing AMI. As estimated bleeding, successfully underwent IRA a single bolus dose unfractionated heparin (UFH) ASA. After PTCA, condition more stabilized, so could ligation Hemoclip device (Medtronic, Natick, MA). Because had only given ASA, UFH procedure. practical implication when has problems therapy, stenting. procedure, ASA (without clopidogrel) needed. This most appropriate strategy 1) active 2) recent surgery 3) an ischemic stroke. However how beneficial effect opened last? What main concern undergoing stenting? Re-occlusion re-occlusion. question asked Controlled Abciximab Device Investigation Lower Late Complications (CADILLAC) trial. this trial, 2,082 were randomized 2 × factorial design primary balloon angioplasty, abciximab. At median days (range 0 23), early re-occlusion occurred 0.5% been versus 1.4% (P = 0.04). So these followed-up closely require benefit repeat PTCA. Complex baseline lesion morphology small vessel size angiographic predictors 1

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