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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...

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Autores principales: Ilic, Ivan, Radunovic, Anja, Timcic, Stefan, Odanovic, Natalija, Radoicic, Dragana, Dukuljev, Natasa, Krljanac, Gordana, Otasevic, Petar, Apostolovic, Svetlana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
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.
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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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