scholarly journals Management of anti-thrombotic therapy in patients with recent percutaneous coronary intervention and acute dengue infection: A case series

2019 ◽  
Vol 28 (4) ◽  
pp. 284-287
Author(s):  
Wishnu Aditya ◽  
Jonathan Yap ◽  
Piotr Chlebicki ◽  
Charles Wah Hak Chan ◽  
Jack Wei Chieh Tan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Dengue Infection ◽  
Case Series ◽  
Coronary Intervention ◽  
Careful Consideration ◽  
Risk Of Bleeding ◽  
Anti Platelet Therapy ◽  
Percutaneous Coronary ◽  
The Ideal

There is currently little data regarding the ideal management for a patient who has undergone recent percutaneous coronary intervention (PCI) and subsequently develops dengue fever. Patients with recent PCI are at high risk of stent thrombosis with cessation of dual anti-platelet therapy. On the other hand, patients with dengue viral infection are at high risk of bleeding. Managing patients with recent PCI and dengue involves the delicate balancing of the risk of thrombosis and bleeding. Careful consideration of the timing of coronary intervention and the severity of the dengue infection is required. We describe the management of the anti-thrombotic therapy in three different patients with dengue infection and recent PCI and discuss our approach to managing such patients.

scholarly journals Antithrombotic therapy in patients with atrial fibrillation and percutaneous coronary intervention: what has changed in the guidelines in 2020?

2020 ◽  
pp. 56-64
Author(s):  
E. P. Panchenko
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Stent Thrombosis ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Antiplatelet Drug ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary

The article presents an analytical review of the studies aimed at determining the optimal antithrombotic therapy in patients with atrial fibrillation undergoing elective or emergency percutaneous coronary intervention (PCI) due to the development of acute coronary syndrome (ACS). The results of the WOEST study are analysed. This study was the first to demonstrate an opportunity to safely discontinue administration of aspirin as part of the multicomponent antithrombotic therapy that included warfarin as an anticoagulant. Three studies were analysed - PIONEER AF-PCI, RE-DUAL-PCI and AUGUSTUS, where direct oral anticoagulants (DOACs) - rivaroxaban, dabigatran and apixaban were used as anticoagulants as part of the multicomponent therapy. The results of these studies formed the backbone of the updated European guidelines for the diagnosis and treatment of atrial fibrillation, 2020. The guidelines offer to divide patients with AF and ACS, who require multicomponent antithrombotic therapy, into two categories. The first group includes AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as patients with a risk of bleeding that prevails over the risk of stent thrombosis. The second category of patients, in contrast, is characterized by a high risk of stent thrombosis, which prevails over the risk of bleeding. In the absence of contraindications, the patients of both categories should choose DOAC as an anticoagulant and be prescribed clopidogrel as a P2Y12 inhibitor for 12 months. In AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as in patients with a risk of bleeding, which prevails over the risk of stent thrombosis, the period of treatment with the second antiplatelet drug (aspirin) should belimited to the hospital stay. Patients at increased risk of stent thrombosis and reduced risk of bleeding can extend the aspirin therapy for 1 month. The approaches to the choice of the duration and composition of the multicomponent antithrombotic therapy in AF patients taking oral anticoagulants after elective PCI are similar to those in ACS patients, except for the duration of clopidogrel therapy, which is reduced to 6 months in all patients.

scholarly journals CRT-600.09 CardioHELP Support for High-Risk Percutaneous Coronary Intervention: A Single Center Case Series

2018 ◽  
Vol 11 (4) ◽  
pp. S44-S45 ◽  
Author(s):  
Derek Antoku ◽  
Wesley Ghasem ◽  
Anilkumar Mehra ◽  
Ray V. Matthews ◽  
Leonardo C. Clavijo ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Case Series ◽  
Coronary Intervention ◽  
Single Center ◽  
Percutaneous Coronary

scholarly journals A dynamic model to estimate evolving risk of major bleeding after percutaneous coronary intervention

2021 ◽  
Author(s):  
Nathan C Hurley ◽  
Nihar Desai ◽  
Sanket Dhruva ◽  
Rohan Khera ◽  
Wade L Schulz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Clinical Information ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Initial Model ◽  
Moderate Risk ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary

Background: Bleeding is a common complication of percutaneous coronary intervention (PCI), leading to significant morbidity, mortality, and cost. While several risk models exist to predict post-PCI bleeding risk, however these existing models produce a single estimate of bleeding risk anchored at a single point in time. These models do not update the risk estimates as new clinical information emerges, despite the dynamic nature of risk. Objective: We sought to develop models that update estimates of patient risk of bleeding over time, enabling a dynamic estimate of risk that incorporates evolving clinical information, and to demonstrate updated predictive performance by incorporating this information. Methods: Using data available from the National Cardiovascular Data Registry (NCDR) CathPCI, we trained 6 different XGBoost tree-based machine learning models to estimate the risk of bleeding at key decision points: 1) choice of access site, 2) prescription of medication prior to PCI, and 3) the choice of closure device. Results: We included 2,868,808 PCIs; 2,314,446 (80.7%) prior to 2014 for training and 554,362 (19.3%) remaining for validation. Discrimination improved from an AUROC of 0.812 (95% Confidence Interval: 0.812-0.812) using only presentation variables to 0.845 (0.845-0.845) using all variables. Among 123,712 patients classified as low risk by the initial model, 14,441 were reclassified as moderate risk (1.4% experienced bleeds), while 723 patients were reclassified as high risk (12.5% experienced bleeds). Among 160,165 patients classified as high risk by the initial model, there were 40 patients reclassified to low risk (0% experienced bleeds), and 43,265 patients reclassified to moderate risk (2.5% experienced bleeds). Conclusion: Accounting for the time-varying nature of data and capturing the association between treatment decisions and changes in risk provide up-to-date information that may guide individualized care throughout a hospitalization.

scholarly journals Case series of high-risk percutaneous coronary intervention with rotational atherectomy under short-term mechanical circulatory support with TandemHeart in the setting of acute myocardial infarction

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6
Author(s):  
Leonie Großekettler ◽  
Bastian Schmack ◽  
Hugo A Katus ◽  
Raffi Bekeredjian ◽  
Philip Raake
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Mechanical Circulatory Support ◽  
Case Series ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Percutaneous Coronary

Abstract Background  TandemHeart is a percutaneous Ventricular Assist Device, most commonly used to provide mechanical circulatory support during high-risk percutaneous coronary intervention and postcardiotomy cardiac failure. However, TandemHeart has not been applied in patients with severe heart failure due to myocardial infarction during high-risk percutaneous coronary intervention with the need for rotational artherectomy (RA) before, so we present a first-in-man case series. Case summary  Three patients with severe HF[Please spell out HF, LA and MI (if necessary).] due to acute myocardial infarction revealed severely calcified lesions of the unprotected left main artery. We successfully used the TandemHeart as percutaneous Ventricular Assist Device during high-risk percutaneous coronary intervention with RA. Discussion  We here report our experience and show that RA under TandemHeart mechanical circulatory support is feasible and safe in case of acute MI.

scholarly journals High-risk percutaneous coronary intervention with Impella CP hemodynamic support. A case series and method presentation

2017 ◽  
Vol 1 ◽  
pp. 67-71
Author(s):  
Adam Sukiennik ◽  
Michał Kasprzak ◽  
Wiesław Mazurek ◽  
Piotr Niezgoda ◽  
Łukasz Bednarczyk ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Case Series ◽  
Coronary Intervention ◽  
Hemodynamic Support ◽  
Percutaneous Coronary

Outcome of Impella 2.5 use in patients undergoing Percutaneous Coronary Intervention in Henan, China: a case series

Perfusion ◽  
2021 ◽  
pp. 026765912110490
Author(s):  
Rafiq Ahmed Bhat ◽  
Syed Manzoor Ali ◽  
Akanksha Rathi ◽  
Javaid Akhter Bhat ◽  
Raja Saqib Iqbal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Case Series ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Hemodynamic Support ◽  
Percutaneous Coronary ◽  
Case Number

Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock (AMI-CS) or heart failure is associated with an unacceptably high in-hospital mortality of 33%–55% and a lost chance to accept PCI (Percutaneous Coronary Intervention). Aim: The aim of the study was to find out whether percutaneous hemodynamic support device Impella 2.5 improves prognosis of high-risk PCI patients or not. Methods: This study was a case series involving six patients who underwent a Left Ventricular Assist Device (LVAD, Impella 2.5, Abiomed, Danvers, MA) implantation after suffering from AMI with a very low ejection fraction and acute heart failure. The clinical experience and outcomes of the patients are hereby discussed. Results: All PCI procedures were safely completed under LVAD support. The hemodynamic parameters of all patients improved clinically over the next 30 days and following 12 months after Impella insertion except in two patients, of which one patient (Case number 6) died 4 days post-Impella protected PCI procedure due to acute left ventricle heart failure with cardiogenic shock and pulmonary oedema; and another one died at 12 months after Impella protected PCI procedure (Case number 4) due to decompensated heart failure and infected pneumonia. Conclusion: Percutaneous hemodynamic support is favorable and feasible during high risk Percutaneous Coronary Intervention (PCI). A bigger study is needed to substantiate the claims of the current study.

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

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