scholarly journals Multiple Recurrent Stent Thrombosis in a Patient with Coexisting Clopidogrel Resistance and Increased Anticardiolipin Antibodies: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Erik H. Middlebrooks ◽  
Mukta Panda
Keyword(s):  
Stent Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Anticardiolipin Antibodies ◽  
Drug Eluting Stents ◽  
Multiple Drug ◽  
Clopidogrel Resistance ◽  
Antibody Titers ◽  
Drug Eluting

The antiphospholipid syndrome (APS) is a common cause of both arterial and venous thrombosis. While studies exist demonstrating the role of APS in coronary artery bypass graft failure, its role in stent thrombosis is less clearly documented. Also, a literature search of PubMed did not reveal any articles regarding the coexistence of clopidogrel resistance and APS despite increasing awareness of resistance to clopidogrel treatment. We present a case of a 59-year-old male having recurrent myocardial infarction after subacute restenosis of multiple drug-eluting stents despite anticoagulant therapy. The patient had in-stent thrombosis of seven drug-eluting stents in a course of eight days. He was subsequently found to have mild elevation of IgG anticardiolipin (aCL) antibody titers and resistance to clopidogrel. Long-term anticoagulation with a combination of low-molecular-weight heparin, clopidogrel, and aspirin has been effective. While the patient's aCL titer level was not elevated above the level required by the current diagnostic criteria for APS, we believe that this patient suffers from the antiphospholipid syndrome. We will discuss some of the controversies surrounding the diagnosis of APS as well as appropriate treatment and recognition of the coexistence of APS and clopidogrel resistance in patients with stent thrombosis.

scholarly journals Simultaneous Two-Vessel Subacute Stent Thrombosis Caused by Clopidogrel Resistance from CYP2C19 Polymorphism

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Ashwad Afzal ◽  
Bimal Patel ◽  
Neel Patel ◽  
Sudhakar Sattur ◽  
Vinod Patel
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Clopidogrel Resistance ◽  
St Segment Elevation ◽  
Cyp2c19 Polymorphism ◽  
Drug Eluting

Clopidogrel resistance from CYP2C19 polymorphism has been associated with stent thrombosis in patients undergoing percutaneous coronary intervention with drug-eluting stents. We present a case of a 76-year-old male who received drug-eluting stents to the right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction and was discharged on dual antiplatelet therapy with aspirin and clopidogrel. He subsequently presented with chest pain from anterior, anteroseptal, and inferior ST segment elevation myocardial infarction. An emergent coronary angiogram revealed acute stent thrombosis with 100% occlusion of RCA and LAD that was successfully treated with thrombus aspiration and angioplasty. Although he was compliant with his dual antiplatelet therapy, he developed stent thrombosis, which was confirmed as clopidogrel resistance from homozygous CYP2C19 polymorphism.

Empirical assessment of the impact of drug-eluting stents on the rate of use of coronary revascularization procedures

2004 ◽  
Vol 20 (3) ◽  
pp. 356-360 ◽  
Author(s):  
Roberto Grilli ◽  
Francesco Taroni
Keyword(s):  
Coronary Artery ◽  
Early Stage ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Policy Implications ◽  
Drug Eluting Stents ◽  
Drug Eluting ◽  
Revascularization Procedures ◽  
The Impact

Objectives:To assess the impact of the availability of drug-eluting stents (DES) in April 2002 in Emilia-Romagna (a four-million resident Italian region), on the rate of use of revascularization procedures. DES are expected to influence the rate of use of coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI). However, to date, little empirical information is available on the actual impact of this innovation on clinical practice.Methods:A time series regression analysis of the monthly number of procedures (PCI and CABG) performed between January 1998 and March 2003.Results:DES availability was associated with statistically significant changes in the use of revascularization procedures, although the size of the effect was always small or moderate. PCI increased only by 0.36 more procedures per month (approximately four per year), whereas more evident was the concurrent reduction of isolated CABG (4.15 fewer per month, that is fifty fewer per year). Overall, considering all the surgical revascularizations (i.e., CAGB both isolated and associated with other interventions), there was a reduction of 2.52 procedures per month (thirty less per year).Conclusions:Despite DES being at a very early stage of their diffusion process, our results indicate that they are already having an impact, although moderate, on the use of revascularization procedures. If these findings will be confirmed, they will have a substantial influence on the patterns of care for patients with coronary artery disease and relevant policy implications for health services.

Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter?

2015 ◽  
Vol 100 (6) ◽  
pp. 2227-2236 ◽  
Author(s):  
Edward L. Hannan ◽  
Ye Zhong ◽  
Chuntao Wu ◽  
Alice K. Jacobs ◽  
Nicholas J. Stamato ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Drug Eluting Stents ◽  
Artery Bypass Graft ◽  
Drug Eluting
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