A Subacute Stent Thrombosis Case Treated By Half Dose Thrombolytic and Glycoprotein IIb/IIIa Receptor Blockers

Abstract

The mortality and morbidity of stent thrombosis are very high. Although subacute stent trombosis of drug eluting stents are similar to bare metal stents, late thrombosis are higher due to delayed endothelization. There is no consensus about the treatment of stent thrombosis and different modalities like balloon angioplasty, urgent by-pass surgery, thrombolytic therapy and half dose thrombolytic therapy plus GPIIb/IIIa receptor blockers infusion all of them have advantages and pitfalls. In this case report a 55 years old male patient who had stent thrombosis due to premature discontinuation of the anti-platelet drugs were treated by half dose thrombolytic therapy (50 mg r-tPA) plus GPIIb/IIIa receptor blockers (tirofiban) infusion. The infarct related artery was observed patent fully in angiography at fifth day of hospitalization. In conclusion we think that half dose thrombolytic therapy plus GPIIb/IIIa receptor blockers infusion is a good alternative in stent thrombosis in patients with low bleeding risks. ©2008, Firat University, Medical Faculty

Keywords

• -

Yarı Doz Trombolitik Ve Glikoprotein IIb/IIIa Reseptör Blokeri İle Tedavi Edilen Subakut Stent Trombozu

Öz

Subakut stent trombozunun mortalite ve morbiditesi oldukça yüksektir. İlaç kaplı stentlerde subakut stent trombozu sıklığı çıplak metal stentlerle benzer oranlarda olmasına karşın endotelizasyon geciktiği için geç tromboz olasılığı daha fazladır. Stent trombozunun tedavisinde balon anjiyoplasti, koroner by-pass operasyonu, trombolitik tedavi uygulaması ve yarı doz trombolitik tedavisine ek olarak verilen GPIIb/IIIa reseptör bloker infüzyonu sayılabilir. Bu olgu sunumunda erken anti-trombosit ilaç kesilmesine bağlı olarak subakut stent trombozu gelişen 55 yaşındaki erkek hasta yarı doz trombolitik (50 mg r-tPA) sonrası GPIIb/IIIa reseptör bloker (tirofiban) infüzyonu ile tedavi edildi. Hastanın yatısının 5. gününde yapılan koroner anjiyografisinde enfarkttan sorumlu arterin tam açık olduğu görüldü. Sonuç olarak kanama riski düşük olan hastalarda yarı doz trombolitik sonrası GPIIb/IIIa reseptör bloker infüzyonunun iyi bir seçenek olduğunu düşünmekteyiz. ©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Stent trombozu, ilaç kaplı stent, trombolitik, glikoprotein IIb/IIIa

Kaynakça

1. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug- eluting stents. JAMA. 2005 May 4; 293: 2126-2130.
2. Ong AT, McFadden EP, Regar E, et al. Late angiographic stent thrombosis (LAST) events with drug eluting stents. J Am Coll Cardiol. 2005; 45: 2088-2092.
3. Joner M, Finn AV, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006 Jul 4; 48: 193-202.
4. Ong AT, Hoye A, Aoki J, et al. Thirty-day incidence and six- month clinical outcome of thrombotic stent occlusion after bare- metal, sirolimus, or paclitaxel stent implantation. J Am Coll Cardiol. 2005 Mar 15; 45: 947-953.
5. Kuchulakanti PK, Chu WW, Torguson R, et al. Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. Circulation. 2006 Feb 28; 113: 1108-1113. Epub 2006 Feb 20.
6. Gersh BJ. Acute myocardial infarction. Results of the ASSENT-3 trial. Rev Cardivasc Med. 2002 Spring; 3: 111-115.
7. Brener SJ, Lincoff AM, Bates ER, et al. The relationship between baseline risk and mortality in ST-elevation acute myocardial infarction treated with pharmacological reperfusion: insights from the Global Utilization of Strategies To open Occluded arteries (GUSTO) V trial. Am Heart J. 2005 Jul; 150: 89-93.
8. Kabul Tarihi:28.12.2006