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An unusual case of stent thrombosis: a case report

BACKGROUND : Stent thrombosis is a serious and potentially life-threatening complication of percutaneous coronary intervention. It often presents dramatically, typically resulting in ST-elevation myocardial infarction which is associated with a high mortality rate. Premature discontinuation of antip...

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Autores principales: Rahman, Atifur, Wong, Sophia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764572/
https://www.ncbi.nlm.nih.gov/pubmed/31660492
http://dx.doi.org/10.1093/ehjcr/ytz119
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author Rahman, Atifur
Wong, Sophia
author_facet Rahman, Atifur
Wong, Sophia
author_sort Rahman, Atifur
collection PubMed
description BACKGROUND : Stent thrombosis is a serious and potentially life-threatening complication of percutaneous coronary intervention. It often presents dramatically, typically resulting in ST-elevation myocardial infarction which is associated with a high mortality rate. Premature discontinuation of antiplatelet therapy in the initial 30 days after stenting is arguably the most important predictor of stent thrombosis. In some cases, discontinuation of therapy is unintentional, such as in patients with short-bowel length or malabsorption syndromes. CASE SUMMARY : A 70-year-old man presented to our hospital with stent thrombosis due to non-absorption of antiplatelet agents, 3 days after an elective percutaneous intervention to the right coronary artery. The patient, who had had a laparoscopic high anterior resection due to previous colorectal cancer, had noticed tablets passing whole into his colostomy bag. Repeat balloon angioplasty and stenting were performed and the patient received further antiplatelet therapy in a crushed form. DISCUSSION : Drug absorption in the gastrointestinal tract is altered when a significant length of the gut has been resected. Reduced intestinal luminal transit time and insufficient contact time with intestinal mucosa leads to reduced bioavailability of drugs and increased risk of stent thrombosis. The aetiology of stent thrombosis can be investigated with intravascular imaging techniques and platelet function testing. Management includes using different drug formulations and doses and monitoring the outcomes of therapy. In some cases, it may also be appropriate to involve a gastroenterology team, preferably in the multidisciplinary environment of an intestinal rehabilitation centre.
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spelling pubmed-67645722019-10-02 An unusual case of stent thrombosis: a case report Rahman, Atifur Wong, Sophia Eur Heart J Case Rep Case Reports BACKGROUND : Stent thrombosis is a serious and potentially life-threatening complication of percutaneous coronary intervention. It often presents dramatically, typically resulting in ST-elevation myocardial infarction which is associated with a high mortality rate. Premature discontinuation of antiplatelet therapy in the initial 30 days after stenting is arguably the most important predictor of stent thrombosis. In some cases, discontinuation of therapy is unintentional, such as in patients with short-bowel length or malabsorption syndromes. CASE SUMMARY : A 70-year-old man presented to our hospital with stent thrombosis due to non-absorption of antiplatelet agents, 3 days after an elective percutaneous intervention to the right coronary artery. The patient, who had had a laparoscopic high anterior resection due to previous colorectal cancer, had noticed tablets passing whole into his colostomy bag. Repeat balloon angioplasty and stenting were performed and the patient received further antiplatelet therapy in a crushed form. DISCUSSION : Drug absorption in the gastrointestinal tract is altered when a significant length of the gut has been resected. Reduced intestinal luminal transit time and insufficient contact time with intestinal mucosa leads to reduced bioavailability of drugs and increased risk of stent thrombosis. The aetiology of stent thrombosis can be investigated with intravascular imaging techniques and platelet function testing. Management includes using different drug formulations and doses and monitoring the outcomes of therapy. In some cases, it may also be appropriate to involve a gastroenterology team, preferably in the multidisciplinary environment of an intestinal rehabilitation centre. Oxford University Press 2019-07-13 /pmc/articles/PMC6764572/ /pubmed/31660492 http://dx.doi.org/10.1093/ehjcr/ytz119 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Rahman, Atifur
Wong, Sophia
An unusual case of stent thrombosis: a case report
title An unusual case of stent thrombosis: a case report
title_full An unusual case of stent thrombosis: a case report
title_fullStr An unusual case of stent thrombosis: a case report
title_full_unstemmed An unusual case of stent thrombosis: a case report
title_short An unusual case of stent thrombosis: a case report
title_sort unusual case of stent thrombosis: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764572/
https://www.ncbi.nlm.nih.gov/pubmed/31660492
http://dx.doi.org/10.1093/ehjcr/ytz119
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