scholarly journals Systemic thrombolysis with tenecteplase in stent thrombosis patients as a life saving measure in odd situations: an observational study from tertiary care hospital

2020 ◽  
Vol 8 (5) ◽  
pp. 1649
Author(s):  
Awadhesh Kumar Sharma ◽  
Neeraj Prakash ◽  
M. M. Razi ◽  
Sameer Sarraf ◽  
Santosh Sinha ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Observational Study ◽  
Stent Thrombosis ◽  
Clinical Success ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Care Hospital ◽  
Systemic Thrombolysis ◽  
Life Saving ◽  
Percutaneous Coronary

Background: Coronary artery stent thrombosis specifically acute stent thrombosis is always a nightmare for interventionist. Stent thrombosis is one of a severe and catastrophic complication of percutaneous coronary intervention (PCI). Repeat PCI is commonly considered the preferred strategy to manage patients with stent thrombosis. Thrombolytic therapy is considered only partially effective.Methods: This was a single centre largest ever observational study on this topic comprising of total 110 patients with history of previous stent implantation and now presented with an acute ST segment elevation myocardial infarction due to a probable stent thrombosis successfully treated with systemic thrombolysis with tenecteplase were studied over the period of 2 years (April 2017 to March 2019).Results: On analyzing data clinical success was reported in 92 (83.6%) patients, electrocardiographic success is seen in 102 (92.7%) patients while angiographic success was reported in 80(72.7%) patients. Cerebrovascular accident were reported in 2 (1.8%) patients which died later on.Conclusions: This study which is the first ever largest observational study on this topic demonstrates that, in patients with probable stent thrombosis and a short time to reperfusion in some specific extraordinary situations where timely percutaneous coronary intervention is not possible, systemic thrombolysis by fibrin specific Tenecteplase can be done as a life saving procedure which is associated with good immediate results.

scholarly journals Clinical outcomes after percutaneous coronary intervention in patients with coronary artery disease: six months results from a single centre study

2019 ◽  
Vol 7 (11) ◽  
pp. 4292
Author(s):  
L. Kiran Kumar Reddy ◽  
Santhosh Satheesh
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Cardiovascular Mortality ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Background: The study aimed to evaluate clinical outcomes in patients with coronary artery diseases (CAD) who underwent percutaneous coronary intervention (PCI), to identify the factors associated with clinical outcomes and survival among such patients, to explore the procedure related complications, and to assess restenosis and stent thrombosis rates following PCI.Methods: This retrospective, single-center, observational study was conducted at a tertiary-care center in India, which included patients with CAD undergoing PCI from January 2016 to December 2016. Angiographic and clinical success and complications related to both procedural and vascular access were noted. Patient were followed-up for clinical outcomes up to 6-months. Primary outcome of the study was all-cause mortality. Secondary outcome measures were cardiovascular mortality, and event free survival, angina, cardiovascular events and restenosis and stent thrombosis.Results: A total of 831 patients were included of which majority were males (83.5%). Smoking was found in 33.7%, diabetes in 35.6%, and hypertension in 37.7%. At 6-months, follow-up was obtained for 711 patients. The clinical composite endpoint seen in 9.8% of patients. Angina (13.2%), acute coronary syndrome (3.1%), stent thrombosis (1.0%), in-stent restenosis (3.9%), cardiovascular and all-cause mortality (2.7%), heart failure (7.3%) and stroke (1.7%) were reported at 6-months follow-up.Conclusions: The PCI in a tertiary-care centre leads to low rates of periprocedural events and low rates of clinical outcomes at 6-months follow-up. Moreover, left ventricular ejection fraction was shown to be major predictor for cardiovascular mortality in post-PCI patients. Hypertension was significantly associated with stroke post-PCI.

scholarly journals Comparison of anti-thrombotic strategies using Bivalirudin, Heparin plus Eptifibatide, and Unfractionated Heparin Monotherapy for acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI): A single-center observational stu

2021 ◽  
Vol 17 (2) ◽  
pp. 91-98
Author(s):  
ABM Golam Mostofa ◽  
Tanjima Parvin ◽  
MRM Mandal ◽  
Pallob Kumar Biswas ◽  
Goutom Chandra Bhowmik ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Unfractionated Heparin ◽  
Stent Thrombosis ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Hemorrhagic Complication ◽  
Single Center ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To determine and compare the incidence of in-hospital and 30-day hemorrhagic complication and major adverse cardiac events (MACEs) as evidence of safety and efficacy using three different anti- thrombotic strategies using Bivalirudin, Heparin plus Eptifibatide (GPI: GP IIb/IIIa inhibitor), and Unfractionated Heparin (UFH) monotherapy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a tertiary care cardiac hospital. Background: UFH or Heparin plus Eptifibatide or Bivalirudin is the most commonly used antithrombotic regimen to improve peri and post-PCI clinical outcomes in a patient undergoing PCI for ACS. Among them, the most effective and optimal antithrombotic regimen for preventing ischemic complications while limiting bleeding risk in ACS patients undergoing PCI is still far from being clear. Methods: 324 ACS patients ( age >18 years and ≤75 years) who underwent PCI from May 2018 to May 2019 at UCC, BSMMU, Dhaka were consecutively enrolled in the study and were divided into three groups according to antithrombotic. The choice of Anti-thrombotic strategy was at the discretion of the operator(s) and the patient’s affordability. Group-A: 107 patients received Bivalirudin as intravenous (I/V) bolus of 0.75 mg/ kg, followed by an infusion of 1.75 mg/kg/hr up to 4 hours. Group-B: 111 patients received UFH as an I/ V bolus of 70-100 U/kg (targeted ACT: 250-300 s). Group-C: 106 patients were administered UFH plus Eptifibatide as per the standard hospital guidelines. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors ( Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complication and MACEs [death, MI, stroke, stent thrombosis and target-vessel revascularization (TVR)] Results: In-hospital outcome: Patients treated with Bivalirudin as compared with UFH had a significantly lower incidence of QMI lesions (0% vs.6%; p=0.038) and major bleeding (0% vs. 7%; p=0.021). The bleeding rate was also significantly lower in Bivalirudin arm as compared with Heparin plus GPI arm (0% vs. 6%; p=0.038). However, the incidence of cardiac death, stent thrombosis, TVR were no differences among the three groups. 30-day outcome: There was only one NQMI in the bivalirudin group as opposed to 8% in the heparin group (p=0.041). No other adverse effects were found significantly different among the study groups. Conclusion: In this perspective, observational study of ACS patients undergoing PCI in a single-center showed that Bivalirudin monotherapy is safer than other contemporary antithrombotic strategies. In terms of efficacy, Bivalirudin is non inferior to Heparin plus Eptifibatde but superior to UFH monotherapy. University Heart Journal Vol. 17, No. 2, Jul 2021; 91-98

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