Treatment of coronary stent thrombosis: Difference between revisions
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Coronary stent thrombosis may cause [[myocardial ischemia]] or [[STEMI|infarction]] and hence treatment strategies are similar to that of [[myocardial infarction]]. Emergent target lesion or target vessel revascularization is the treatment of choice in stent thrombosis. Revascularization may be carried out by [[PCI]] or in some instances, [[thrombolytics]] <ref name="pmid15728650">{{cite journal |author=Wenaweser P, Rey C, Eberli FR, Togni M, Tüller D, Locher S, Remondino A, Seiler C, Hess OM, Meier B, Windecker S |title=Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome |journal=[[European Heart Journal]] |volume=26 |issue=12 |pages=1180–7 |year=2005 |month=June |pmid=15728650 |doi=10.1093/eurheartj/ehi135 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15728650 |accessdate=2011-05-05}}</ref>. If revascularization is not successful, urgent [[CABG]] should be considered. | Coronary stent thrombosis may cause [[myocardial ischemia]] or [[STEMI|infarction]] and hence treatment strategies are similar to that of [[myocardial infarction]]. Emergent target lesion or target vessel revascularization is the treatment of choice in stent thrombosis. Revascularization may be carried out by [[PCI]] or in some instances, [[thrombolytics]] <ref name="pmid15728650">{{cite journal |author=Wenaweser P, Rey C, Eberli FR, Togni M, Tüller D, Locher S, Remondino A, Seiler C, Hess OM, Meier B, Windecker S |title=Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome |journal=[[European Heart Journal]] |volume=26 |issue=12 |pages=1180–7 |year=2005 |month=June |pmid=15728650 |doi=10.1093/eurheartj/ehi135 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15728650 |accessdate=2011-05-05}}</ref>. If revascularization is not successful, urgent [[CABG]] should be considered. | ||
The probable cause of stent thrombosis should be evaluated as treatment may vary with etiology. | |||
The | If the patient develops stent thrombosis while on [[clopidogrel]], it may suggest that the patient was not responsive to clopidrogrel therapy. TRITON TIMI 38 trial<ref name="pmid19249633">{{cite journal |author=Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, Antman EM |title=Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial |journal=[[Lancet]] |volume=373 |issue=9665 |pages=723–31 |year=2009 |month=February |pmid=19249633 |doi=10.1016/S0140-6736(09)60441-4 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)60441-4 |issn= |accessdate=2010-06-30}}</ref> demonstrated that newer antiplatelet agents such as [[prasugrel]]<ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20 |pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17982182&promo=ONFLNS19 |issn= |accessdate=2010-06-30}}</ref> may be used after weighing the risks of bleeding against benefits of decreased recurrence of stent thrombosis/coronary events. | ||
If revascularization with stent placement is planned, risks and benefits of [[DES]] vs [[BMS]] should be carefully assessed depending on risk of bleeding and patient compliance. ACC recommends that continuation of clopidogrel or prasugrel beyond 15 months should be considered in patients undergoing drug eluting stent placement<ref name="2009 STEMI guidelines">[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>. | |||
Patients who present with stent thrombosis after completing the recommended duration of treatment with [[clopidogrel]] restarting clopidogrel 75 mg daily along with [[aspirin]] and continuing for a minimum of one year should be considered. | |||
==Sources== | |||
The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI<ref name="2009 STEMI guidelines">[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref> | |||
==References== | ==References== | ||
Revision as of 00:09, 15 May 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Treatment of coronary stent thrombosis
Coronary stent thrombosis may cause myocardial ischemia or infarction and hence treatment strategies are similar to that of myocardial infarction. Emergent target lesion or target vessel revascularization is the treatment of choice in stent thrombosis. Revascularization may be carried out by PCI or in some instances, thrombolytics [1]. If revascularization is not successful, urgent CABG should be considered.
The probable cause of stent thrombosis should be evaluated as treatment may vary with etiology.
If the patient develops stent thrombosis while on clopidogrel, it may suggest that the patient was not responsive to clopidrogrel therapy. TRITON TIMI 38 trial[2] demonstrated that newer antiplatelet agents such as prasugrel[3] may be used after weighing the risks of bleeding against benefits of decreased recurrence of stent thrombosis/coronary events.
If revascularization with stent placement is planned, risks and benefits of DES vs BMS should be carefully assessed depending on risk of bleeding and patient compliance. ACC recommends that continuation of clopidogrel or prasugrel beyond 15 months should be considered in patients undergoing drug eluting stent placement[4].
Patients who present with stent thrombosis after completing the recommended duration of treatment with clopidogrel restarting clopidogrel 75 mg daily along with aspirin and continuing for a minimum of one year should be considered.
Sources
The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI[4]
References
- ↑ Wenaweser P, Rey C, Eberli FR, Togni M, Tüller D, Locher S, Remondino A, Seiler C, Hess OM, Meier B, Windecker S (2005). "Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome". European Heart Journal. 26 (12): 1180–7. doi:10.1093/eurheartj/ehi135. PMID 15728650. Retrieved 2011-05-05. Unknown parameter
|month=ignored (help) - ↑ Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, Antman EM (2009). "Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial". Lancet. 373 (9665): 723–31. doi:10.1016/S0140-6736(09)60441-4. PMID 19249633. Retrieved 2010-06-30. Unknown parameter
|month=ignored (help) - ↑ Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". The New England Journal of Medicine. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182. Retrieved 2010-06-30. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 [1]