Limits...
Recurrent acute coronary syndrome and restenosis after percutaneous coronary intervention in a patient with idiopathic thrombocytopenic purpura: a case report and literature review.

Li-Sha G, Peng C, Yue-Chun L - BMC Cardiovasc Disord (2015)

Bottom Line: The safety of antiplatelet therapy and PCI in patients who have ACS and ITP is unknown.He was treated successfully with cutting balloon angioplasty under anticoagulation with unfractionated heparin and antiagregation with acetylsalicylic acid and clopidogrel.Available data suggest that PCI can be safe and feasible, and the risk-benefit equation of PCI procedures and antiplatelet therapies should be carefully evaluated, and the treatment should be individualized.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. gelisa@sina.com.

ABSTRACT

Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute and chronic complications following percutaneous coronary intervention (PCI). Platelet inhibition is a cornerstone in the management of these patients. Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder characterized by premature platelet destruction mediated by autoantibodies. The safety of antiplatelet therapy and PCI in patients who have ACS and ITP is unknown. The aim of the present study is to discuss the management strategies for patients who have ACS and ITP and to review limited data available in the literature.

Case presentation: We report the case of a patient with ITP who underwent three separate coronary interventions. The first PCI with stenting was performed in the left anterior descending artery 5 years ago while the patient suffered an anterior acute myocardial infarction, and the platelet count at admission was 90 × 10(9)/L. The patient presented with recurrent ACS and severe in-stent restenosis 5 years after the first PCI, and the platelet count at admission was 18 × 10(9)/L, and elevated to 87 × 10(9)/L after platelets transfusion. He was treated successfully with cutting balloon angioplasty under anticoagulation with unfractionated heparin and antiagregation with acetylsalicylic acid and clopidogrel. Four months later after cutting balloon angioplasty, the patient received an intracoronary stent when he once again presented with recurrent ACS in the setting of restenosis. The patient has been observed for 1.5 years without restenosis after the third PCI.

Conclusion: We reviewed all the cases in the literature involving PCI and discussed the management strategies in patients with ITP and ACS. Available data suggest that PCI can be safe and feasible, and the risk-benefit equation of PCI procedures and antiplatelet therapies should be carefully evaluated, and the treatment should be individualized.

No MeSH data available.


Related in: MedlinePlus

Coronary angiography in a CRA projection (a) and an RAO + CAU projection (b) showing stent patency 11 months after stenting performed in in-stent restenotic lesion (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4574573&req=5

Fig4: Coronary angiography in a CRA projection (a) and an RAO + CAU projection (b) showing stent patency 11 months after stenting performed in in-stent restenotic lesion (arrow)

Mentions: He was then discharged on aspirin, clopidogrel, atorvastatin and oral methylprednisolone. Clopidogrel was discontinued 1 year after the procedure. During 18-month follow-up, the patient remained clinically free of symptoms without any ischemia events or bleeding complications. Coronary angiography showed stent patency at 11 months’ follow-up (Fig. 4a, b). The platelet count remained stable.Fig. 4


Recurrent acute coronary syndrome and restenosis after percutaneous coronary intervention in a patient with idiopathic thrombocytopenic purpura: a case report and literature review.

Li-Sha G, Peng C, Yue-Chun L - BMC Cardiovasc Disord (2015)

Coronary angiography in a CRA projection (a) and an RAO + CAU projection (b) showing stent patency 11 months after stenting performed in in-stent restenotic lesion (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4574573&req=5

Fig4: Coronary angiography in a CRA projection (a) and an RAO + CAU projection (b) showing stent patency 11 months after stenting performed in in-stent restenotic lesion (arrow)
Mentions: He was then discharged on aspirin, clopidogrel, atorvastatin and oral methylprednisolone. Clopidogrel was discontinued 1 year after the procedure. During 18-month follow-up, the patient remained clinically free of symptoms without any ischemia events or bleeding complications. Coronary angiography showed stent patency at 11 months’ follow-up (Fig. 4a, b). The platelet count remained stable.Fig. 4

Bottom Line: The safety of antiplatelet therapy and PCI in patients who have ACS and ITP is unknown.He was treated successfully with cutting balloon angioplasty under anticoagulation with unfractionated heparin and antiagregation with acetylsalicylic acid and clopidogrel.Available data suggest that PCI can be safe and feasible, and the risk-benefit equation of PCI procedures and antiplatelet therapies should be carefully evaluated, and the treatment should be individualized.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. gelisa@sina.com.

ABSTRACT

Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute and chronic complications following percutaneous coronary intervention (PCI). Platelet inhibition is a cornerstone in the management of these patients. Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder characterized by premature platelet destruction mediated by autoantibodies. The safety of antiplatelet therapy and PCI in patients who have ACS and ITP is unknown. The aim of the present study is to discuss the management strategies for patients who have ACS and ITP and to review limited data available in the literature.

Case presentation: We report the case of a patient with ITP who underwent three separate coronary interventions. The first PCI with stenting was performed in the left anterior descending artery 5 years ago while the patient suffered an anterior acute myocardial infarction, and the platelet count at admission was 90 × 10(9)/L. The patient presented with recurrent ACS and severe in-stent restenosis 5 years after the first PCI, and the platelet count at admission was 18 × 10(9)/L, and elevated to 87 × 10(9)/L after platelets transfusion. He was treated successfully with cutting balloon angioplasty under anticoagulation with unfractionated heparin and antiagregation with acetylsalicylic acid and clopidogrel. Four months later after cutting balloon angioplasty, the patient received an intracoronary stent when he once again presented with recurrent ACS in the setting of restenosis. The patient has been observed for 1.5 years without restenosis after the third PCI.

Conclusion: We reviewed all the cases in the literature involving PCI and discussed the management strategies in patients with ITP and ACS. Available data suggest that PCI can be safe and feasible, and the risk-benefit equation of PCI procedures and antiplatelet therapies should be carefully evaluated, and the treatment should be individualized.

No MeSH data available.


Related in: MedlinePlus