Periprocedural antithrombotic treatment in complex percutaneous coronary intervention

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Panayotis K Vlachakis ◽  
Charalampos Varlamos ◽  
Despoina-Rafailia Benetou ◽  
Ioannis Kanakakis ◽  
Dimitrios Alexopoulos
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Antithrombotic Treatment ◽  
Percutaneous Coronary ◽  
Complex Percutaneous Coronary Intervention

scholarly journals Antithrombotic Therapy in Complex Percutaneous Coronary Intervention Patients Requiring Chronic Anticoagulation

2021 ◽  
Vol 15 ◽  
Author(s):  
Despoina-Rafailia Benetou ◽  
Panayotis K Vlachakis ◽  
Charalampos Varlamos ◽  
Dimitrios Alexopoulos
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Randomized Trials ◽  
Coronary Intervention ◽  
Antithrombotic Treatment ◽  
Percutaneous Coronary ◽  
Complex Percutaneous Coronary Intervention ◽  
Triple Antithrombotic Therapy ◽  
Optimal Treatment Strategy

The optimal antithrombotic treatment in patients receiving oral anticoagulation undergoing percutaneous coronary intervention (PCI) has been a field of intensive research. Although triple antithrombotic therapy had been, until lately, the strategy of choice, recent evidence points to the superiority of dual antithrombotic therapy regarding bleeding prevention, without significantly compromising efficacy. In the further challenging scenario of complex PCI, associated with a higher ischemic risk, the efficacy of an aspirin-free strategy, adopted shortly after the index event is under question, rendering decision-making a fairly difficult scenario for clinicians. Since patients with an indication for oral anticoagulation undergoing complex PCI are underrepresented in randomized trials, there are scarce data regarding the optimal treatment strategy in such patients. This review aims to analyze and compare different approaches regarding the type and duration of antithrombotic regimens, focusing on both safety and efficacy outcomes, as well as to discuss recent guidelines’ suggestions regarding the therapeutic approach in patients receiving oral anticoagulation undergoing PCI procedures of increased complexity.

scholarly journals Antithrombotic Treatment After Coronary Intervention: Agreement and Controversy

2020 ◽  
Vol 15 ◽  
Author(s):  
Tamara García Camarero ◽  
José M de la Torre Hernández
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
New Drugs ◽  
Antithrombotic Treatment ◽  
The Past ◽  
Percutaneous Coronary ◽  
The Subject ◽  
Clinical Conditions ◽  
Combination Regimens

Percutaneous revascularisation has evolved dramatically in the past few decades. The approach to the management of ischaemic heart disease has changed due to the development of new devices and techniques as well as the availability of new drugs and treatment strategies. Its use in combination with antiplatelet therapies has been essential to protect against stent thrombosis. The length of time this combination therapy is used has been modified in recent years and has been the subject of extensive research. The effect of prolonging the time it is taken or shortening it has been evaluated in different clinical conditions. In practice, the decisions regarding antithrombotic therapy after percutaneous coronary intervention are informed by the patient’s profile and the characteristics of the procedures performed. In this article, we review the use of antiplatelet/anticoagulant therapy after percutaneous coronary intervention focusing on trials and guidelines addressing variable durations for combination regimens and the alternatives.

scholarly journals Non-ST-elevation myocardial infarction after complex percutaneous coronary intervention and transcatheter aortic valve implantation: a case report of bioprosthesis-related delayed coronary obstruction and its difficult diagnosis

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Piotr Nikodem Rudziński ◽  
Markus Mach ◽  
Christoph Gross ◽  
Martin Andreas
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Transcatheter Aortic Valve ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Aortic Valve Implantation ◽  
Complex Percutaneous Coronary Intervention ◽  
Valve Implantation ◽  
Coronary Obstruction

Abstract Background There is a high coincidence of significant coronary artery disease and severe aortic stenosis. Coronary revascularization should be performed prior to transcatheter aortic valve implantation (TAVI). We report a case of non-ST-elevation myocardial infarction (NSTEMI) after complex percutaneous coronary intervention (PCI) prior to TAVI, where differential diagnosis between coronary stent failure and bioprosthesis-related sinus obstruction was substantial. Case summary A 79-year-old woman was re-admitted to the hospital 5 days after TAVI due to troponin-negative new-onset angina. She underwent complex PCI 3 days before TAVI and was not compliant to medications. Symptoms initially resolved after re-establishment of anti-hypertensive treatment. There were no signs of aortic bioprosthesis failure, paravalvular leak, or myocardial ischaemia. After 1 month, the symptoms re-occurred. Due to elevated troponins, myocardial ischaemia in electrocardiogram and new contractility disorders, NSTEMI was diagnosed. Because it was impossible to intubate the left coronary artery (LCA), cardiac surgery was performed. Calcified native coronary leaflet was pushed by the stent frame of aortic bioprosthesis towards LCA ostium causing its subtotal occlusion. Transcatheter heart valve (THV) was removed and the new surgical aortic bioprosthesis was implanted. Further hospitalization and 1-month follow-up were uneventful. Discussion Pre-procedural assessment is crucial prior to THV interventions. Delayed coronary obstruction caused by the native leaflet is extremely rare and potentially fatal complication of TAVI. The diagnosis is difficult and high clinical suspicion is required to detect this pathology. Given our experience, the indication towards interventional or surgical repair should be established faster to avoid coronary ischaemia.

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