Volumen: 17 # Number : 2
Publication Date : Mayo - Agosto Year: 2013
Authors: Duarte PJ, Schutz N, Coqui G, Arrinda-Calzeta J , Santagiuliana
S, Perfetti L, Korin J.
Abstract: The optimal management of patients with drug eluting stents under dual antiplatelet therapy who need urgent surgery is unknown. This paper describes the evolution of a patient with recent drug eluting stents who needed emergency surgery.
A 57 years old patient was admitted with a non Q myocardial infarction. Drug eluting stents were placed in proximal left coronary artery, anterior descending and circumflex branch. 48 hs later a severe rectal bleeding developed, and a tumoral
lesion in the recto-sigmoid junction was disclosed. He was treated with blood transfusions and arterial embolization. The anatomo-pathological diagnosis of the tumoral lesion was adenocarcinoma. The patient was discharged and because of the proximity with the acute coronary syndrome an oncologic surgery was planned in 30 days.
Two weeks later, he was re admitted due to acute abdominal pain and needed emergency surgery while receiving clopidogrel
75 mg /day and ASA 100 mg/day. 1 platelet unit per 10 kg was transfused. A perforated rectal tumor was found and left colectomy was performed. 4 hours later i.v. tirofiban infusion was started at a rate of 0,1 ug/kg/min without loading dose, plus i.v. ASA 200 mg/day. Two days later he was able to re-start oral clopidogrel with a loading dose of 300 mg and then 75 mg/day plus oral ASA 100 mg/day and tirofiban was discontinued.
He had neither active bleeding nor acute coronary ischemic events during his hospital stay.
We conclude that short lived GP IIb/IIIa inhibitors such as tirofiban,
could be an effective and relatively safe bridging therapy.
Key words: tirofiban, drug eluting stent, bridging therapy, stent thrombosis.
Pages : 133-136
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