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Drugs for spontaneous coronary dissection: a few untrusted options
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that is often overlooked, misdiagnosed, and maltreated. Medical treatment poses a significant challenge because of the lack of randomized studies to guide treatment. The initial clinical presentation should guid...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10667692/ https://www.ncbi.nlm.nih.gov/pubmed/38028484 http://dx.doi.org/10.3389/fcvm.2023.1275725 |
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author | Ilic, Ivan Radunovic, Anja Timcic, Stefan Odanovic, Natalija Radoicic, Dragana Dukuljev, Natasa Krljanac, Gordana Otasevic, Petar Apostolovic, Svetlana |
author_facet | Ilic, Ivan Radunovic, Anja Timcic, Stefan Odanovic, Natalija Radoicic, Dragana Dukuljev, Natasa Krljanac, Gordana Otasevic, Petar Apostolovic, Svetlana |
author_sort | Ilic, Ivan |
collection | PubMed |
description | Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that is often overlooked, misdiagnosed, and maltreated. Medical treatment poses a significant challenge because of the lack of randomized studies to guide treatment. The initial clinical presentation should guide medical and interventional management. Fibrinolytic agents and anticoagulants should be avoided because they could favor hematoma propagation. In patients with SCAD, antiplatelet therapy should be prescribed especially dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel, whereas potent P2Y12 inhibitors, e.g., ticagrelor and prasugrel, should be avoided. If a stent was used, DAPT should be continued for 12 months. Aspirin only can be an option for patients without “high-risk” angiographic features—thrombus burden, critical stenosis, and decreased coronary flow. Beta-blocking (BB) agents should be used to prevent recurrence of SCAD. There is a general agreement that angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, mineralocorticoid antagonists, and loop diuretics should be used in patients with SCAD experiencing the symptoms of heart failure and a decrease in left ventricular ejection fraction below 50%. Although without firm evidence, statins can be used in SCAD due to their pleiotropic properties. The results of a randomized trial on the use of BB and statins are awaited. Aggregation of data from national registries might point out truly beneficial medications for patients with SCAD. |
format | Online Article Text |
id | pubmed-10667692 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-106676922023-01-01 Drugs for spontaneous coronary dissection: a few untrusted options Ilic, Ivan Radunovic, Anja Timcic, Stefan Odanovic, Natalija Radoicic, Dragana Dukuljev, Natasa Krljanac, Gordana Otasevic, Petar Apostolovic, Svetlana Front Cardiovasc Med Cardiovascular Medicine Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that is often overlooked, misdiagnosed, and maltreated. Medical treatment poses a significant challenge because of the lack of randomized studies to guide treatment. The initial clinical presentation should guide medical and interventional management. Fibrinolytic agents and anticoagulants should be avoided because they could favor hematoma propagation. In patients with SCAD, antiplatelet therapy should be prescribed especially dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel, whereas potent P2Y12 inhibitors, e.g., ticagrelor and prasugrel, should be avoided. If a stent was used, DAPT should be continued for 12 months. Aspirin only can be an option for patients without “high-risk” angiographic features—thrombus burden, critical stenosis, and decreased coronary flow. Beta-blocking (BB) agents should be used to prevent recurrence of SCAD. There is a general agreement that angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, mineralocorticoid antagonists, and loop diuretics should be used in patients with SCAD experiencing the symptoms of heart failure and a decrease in left ventricular ejection fraction below 50%. Although without firm evidence, statins can be used in SCAD due to their pleiotropic properties. The results of a randomized trial on the use of BB and statins are awaited. Aggregation of data from national registries might point out truly beneficial medications for patients with SCAD. Frontiers Media S.A. 2023-11-10 /pmc/articles/PMC10667692/ /pubmed/38028484 http://dx.doi.org/10.3389/fcvm.2023.1275725 Text en © 2023 Ilic, Radunovic, Timcic, Odanovic, Radoicic, Dukuljev, Krljanac, Otasevic and Apostolovic. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Ilic, Ivan Radunovic, Anja Timcic, Stefan Odanovic, Natalija Radoicic, Dragana Dukuljev, Natasa Krljanac, Gordana Otasevic, Petar Apostolovic, Svetlana Drugs for spontaneous coronary dissection: a few untrusted options |
title | Drugs for spontaneous coronary dissection: a few untrusted options |
title_full | Drugs for spontaneous coronary dissection: a few untrusted options |
title_fullStr | Drugs for spontaneous coronary dissection: a few untrusted options |
title_full_unstemmed | Drugs for spontaneous coronary dissection: a few untrusted options |
title_short | Drugs for spontaneous coronary dissection: a few untrusted options |
title_sort | drugs for spontaneous coronary dissection: a few untrusted options |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10667692/ https://www.ncbi.nlm.nih.gov/pubmed/38028484 http://dx.doi.org/10.3389/fcvm.2023.1275725 |
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