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Acute multi-vessel coronary stent thrombosis.
MedLine Citation:
PMID:  18823736     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: Coronary artery stent thrombosis is a rare but often fatal complication associated with percutaneous coronary intervention (PCI) using both bare-metal stents and drug-eluting stents. Although strict adherence to dual anti-platelet therapy (aspirin plus clopidogrel) minimizes this risk, stent thrombosis will still occur in rare patients, leading to acute, subacute, or late life-threatening acute coronary syndromes. Objectives: To present a rare case of acute stent thrombosis involving multiple vessels to increase awareness of this life-threatening condition among emergency physicians, and to review the current guidelines for anti-platelet therapy in this patient population. Case Report: A 52-year-old man who underwent PCI using drug-eluting stents in two separate coronary vessels presented to the Emergency Department within 2 h of discharge from the hospital with chest pain, dynamic electrocardiogram changes, and elevated cardiac markers. Despite compliance with the current recommendations for post-PCI anti-platelet therapy, urgent repeat catheterization revealed total thrombotic occlusion of both stents, requiring urgent repeat intervention. Conclusion: Despite patient compliance with the currently recommended anti-platelet regimen after stent therapy for coronary artery disease, acute stent thrombosis remains a rare but life-threatening risk in both the immediate and delayed post-intervention period. In addition, premature cessation of this anti-platelet therapy stands as the greatest risk factor for such thrombotic events. This case is presented to inform emergency physicians of the current post-PCI anticoagulation recommendations to help mitigate the risk of such complications.
Authors:
Matthew W Lawrence; Michael J Matteucci; Luthur I Carter; Matthew S Shepherd
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Publication Detail:
Type:  Journal Article     Date:  2008-09-26
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  41     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e43-8     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
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