Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient

Tranexamic acid (TXA) is an antifibrinolytic which minimises bleeding and transfusions, with thrombotic risk. Our patient had known coronary artery disease with post-TXA acute ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis. He had five drug-eluting stents (DES): two overlapping DES in mid-LAD (3 years ago), and two overlapping DES in distal right coronary artery and one DES in obtuse-marginal (1.5 years ago). After TXA, both overlapping stent locations thrombosed. Of nine reports of post-TXA acute MI, only one had complex stent anatomy (bifurcation stent to left circumflex/first obtuse-marginal) with other single stents, and only the complex stent thrombosed. Post-TXA MI was more often STEMI caused by arterial thrombosis, rather than non-STEMI caused by blood loss, hypotension or demand ischaemia. Overlapping and bifurcation stents thrombosed; single stents remained patent. In conclusion, overlapping stents, bifurcation stents, excessive stent length and previous in-stent restenosis/thrombosis may increase thrombotic risk. TXA should be administered cautiously with complex stent anatomy.

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Romanian Patients Who Experience in-Stent Restenosis After St-Elevation Myocardial Infarction: The Experience of a Tertiary Center

Internal Medicine ◽

10.2478/inmed-2021-0154 ◽

2021 ◽

Vol 18 (2) ◽

pp. 7-13

Author(s):

Alice Elena Munteanu ◽

Liviu Chiriac ◽

Filip Romi Bolohan ◽

Daniel Niţă ◽

Ruxandra Constantinescu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery ◽

St Elevation Myocardial Infarction ◽

Warning Sign ◽

Stent Restenosis ◽

Tertiary Center ◽

History Of ◽

St Elevation ◽

In Stent Restenosis

Abstract Background and aim. Coronary artery disease (CAD) is one of the most important causes of death worldwide. ST-elevation myocardial infarction (STEMI) is an acute form of presentation in patients with CAD. Percutaneous coronary intervention (PCI) is the treatment of choice in STEMI patients. Generally, a stent is placed after the culprit lesion is dilated in order to ensure the patency of the coronary artery. In-stent restenosis (ISR) is a possible chronic complication in this setting. The following study is one of the few of its kind, since it investigates ISR in a cohort of Romanian patients who underwent PCI in the setting of STEMI. Our current descriptive study aims at highlighting the characteristics of these patients and identifying potential risk factors in this specific population, which could be validated by a further larger study. Methods. We studied 68 patients from “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest, Romania, who presented with STEMI in 2016. The mean time for angiographic reevaluation was 111 days. Results. 94% (64) of the patients underwent primary PCI, while in 6% (4) of the cases thrombolysis was initially attempted before PCI. The most prevalent risk factors that we identified were: arterial hypertension (61%), dyslipidemia (60%) and smoking or history of smoking (47%). The anterior myocardial infarction was the most prevalent (49%). Only 6% of the patients had a documented history of CAD, while on the other hand chronic occlusions were observed in most patients (85%). Of note is that only 11% of the patients reported recurrent angina before the angiographic reevaluation. Conclusion. Common cardiovascular risk factors are also involved in ISR. Their poor management in the case of Romanian patients with STEMI increases the risk of ISR. The lack of symptoms in patients with ISR constitutes a warning sign for clinicians and shows that ISR is a complication which can be easily omitted. Therefore, its incidence is probably underestimated.

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Use of intracoronary imaging in ST Elevation Myocardial Infarction with coronary artery aneurysm and very late stent thrombosis

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.05.087 ◽

2015 ◽

Vol 197 ◽

pp. 296-299 ◽

Cited By ~ 3

Author(s):

Jiang Ming Fam ◽

Jors N. van der Sijde ◽

Antonios Karanasos ◽

Buchun Zhang ◽

Robert-Jan van Geuns ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Stent Thrombosis ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

St Elevation Myocardial Infarction ◽

Late Stent Thrombosis ◽

Very Late Stent Thrombosis ◽

Intracoronary Imaging ◽

St Elevation

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Significant excess of early deaths after prehospital ticagrelor: The ATLANTIC trial challenge

Thrombosis and Haemostasis ◽

10.1160/th14-11-0936 ◽

2015 ◽

Vol 114 (07) ◽

pp. 7-8 ◽

Cited By ~ 3

Author(s):

Vasily Cherepanov ◽

Alexander Dukhanin ◽

Victor Serebruany

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Stent Thrombosis ◽

Clinical Benefit ◽

Odds Ratio ◽

St Elevation Myocardial Infarction ◽

Coronary Reperfusion ◽

Significant Excess ◽

St Elevation ◽

Early Benefit

SummaryThe recently published Administration of Ticagrelor in the Cath Lab or in the Ambulance for New ST Elevation Myocardial Infarction to Open the Coronary Artery (ATLANTIC) trial concluded that prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. The ATLANTIC data fully support the PLATO Angiographic Substudy denying early benefit of ticagrelor, and correspond well with lack of immediate clinical benefit including the early PCI “death paradox„ in PLATO-USA patients. Finally, there were significantly (p=0.043) more deaths in early ticagrelor ATLANTIC arm (odds ratio 3.18 (1.02–9.90) challenging stent thrombosis reduction. Indeed, ATLANTIC represents an important step for our better understanding of ticagrelor, although the confirmation of the PLATO mortality wonder in an adequately powered PEGASUS (TIMI-54) to be reported in 2015 will be vital for ticagrelor future.

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