Safe and Effective Management of Antiplatelet Therapy in a Clopidogrel-Naive Patient Undergoing "Ad Hoc" Complex Coronary Intervention: A Case Report.
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
05
08
2019
revised:
22
09
2019
accepted:
02
10
2019
pubmed:
13
11
2019
medline:
13
8
2021
entrez:
13
11
2019
Statut:
ppublish
Résumé
"Ad hoc" percutaneous coronary intervention (PCI) is a frequent practice as reported in large real-life registries, but most of the patients undergo PCI without being on full and effective dual antiplatelet therapy or clopidogrel is administered orally only a few minutes before the beginning of the procedure. This practice, especially in complex PCI, could be affected by a higher rate of peri-procedural adverse events. We present the case of a 72-year old male diabetic, hypertensive and hyperlipidemic, clopidogrel-naïve, with stable angina who underwent coronary angiography showing several tight stenoses on the left descending artery (LAD) and followed by a chronic total occlusion (CTO) of the vessel. The two main diagonal branches were severely stenosed at the origin as well. Due to patient's decision an ad hoc complex PCI (CTO and multiple Bifurcations) was successfully performed using cangrelor, instead of cath-lab clopidogrel pretreatment, in order to reduce the incidence of peri-procedural myocardial infarction risk, as suggested by recent evidence. Finally, the patient was started on dual antiplatelet therapy with ticagrelor, as guidelines recommend to consider in complex procedures, and discharged 48 h later without complications or significant increases of myocardial enzymes. Current Guidelines recommend loading dose (I/A) or pre-treatment with clopidogrel, nevertheless trials have not demonstrated its benefit, unlike cangrelor. This case highlights the role of aggressive antiplatelet therapy administered in the cath lab to reduce periprocedural ischemic events during elective treatment of complex lesions requiring multiple stenting in clopidogrel-naïve patients.
Sections du résumé
BACKGROUND
"Ad hoc" percutaneous coronary intervention (PCI) is a frequent practice as reported in large real-life registries, but most of the patients undergo PCI without being on full and effective dual antiplatelet therapy or clopidogrel is administered orally only a few minutes before the beginning of the procedure. This practice, especially in complex PCI, could be affected by a higher rate of peri-procedural adverse events.
CASE SUMMARY
We present the case of a 72-year old male diabetic, hypertensive and hyperlipidemic, clopidogrel-naïve, with stable angina who underwent coronary angiography showing several tight stenoses on the left descending artery (LAD) and followed by a chronic total occlusion (CTO) of the vessel. The two main diagonal branches were severely stenosed at the origin as well. Due to patient's decision an ad hoc complex PCI (CTO and multiple Bifurcations) was successfully performed using cangrelor, instead of cath-lab clopidogrel pretreatment, in order to reduce the incidence of peri-procedural myocardial infarction risk, as suggested by recent evidence. Finally, the patient was started on dual antiplatelet therapy with ticagrelor, as guidelines recommend to consider in complex procedures, and discharged 48 h later without complications or significant increases of myocardial enzymes.
DISCUSSION
Current Guidelines recommend loading dose (I/A) or pre-treatment with clopidogrel, nevertheless trials have not demonstrated its benefit, unlike cangrelor. This case highlights the role of aggressive antiplatelet therapy administered in the cath lab to reduce periprocedural ischemic events during elective treatment of complex lesions requiring multiple stenting in clopidogrel-naïve patients.
Identifiants
pubmed: 31711817
pii: S1553-8389(19)30657-8
doi: 10.1016/j.carrev.2019.10.008
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Clopidogrel
A74586SNO7
Ticagrelor
GLH0314RVC
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
80-82Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.