Stent implantation has greatly decreased the frequency of acute closure and restenosis after percutaneous coronary inter-vention (PCI) .But stent thrombosis continues to be observed in approximately 1% to 2% of unsele...Stent implantation has greatly decreased the frequency of acute closure and restenosis after percutaneous coronary inter-vention (PCI) .But stent thrombosis continues to be observed in approximately 1% to 2% of unselected stent procedures and remains a devastating complication.Herein we present a case of subacute coronary stent thrombosis in a patient with anterior AMI treated with double antiplatelet drugs and low molecular weight heparin.展开更多
BACKGROUND The use of apixaban in chronic hemodialysis(HD)patients for non-valvular atrial fibrillation(NVAF)is still controversial regarding benefit of stroke protection vs risk of bleeding.Rotational thromboelastome...BACKGROUND The use of apixaban in chronic hemodialysis(HD)patients for non-valvular atrial fibrillation(NVAF)is still controversial regarding benefit of stroke protection vs risk of bleeding.Rotational thromboelastometry(ROTEM)is a point of care method that evaluates clot formation in whole blood and has been used as an evaluation tool for bleeding risk assessment in non-HD apixaban users.AIM To determine whether bleeding risk can be predicted using ROTEM activated with tissue factor(EXTEM)in HD patients receiving apixaban for NVAF.METHODS Nineteen HD patients with NVAF treated with apixaban for at least 8 days were enrolled.Four dosing regimens were recorded as prescribed by their physician,from 2.5 mg once daily on a non-dialysis day to 5 mg twice daily.Standard coagulation tests,along with ROTEM and apixaban drug levels(using liquid anti-Xa assay)were performed once on a non-dialysis day before and two hours after apixaban morning pill administration.Patients were subsequently monitored for thrombotic/bleeding events and all-cause mortality.RESULTS Over a median follow-up period of 36 months,six patients experienced a bleeding event(group A)and 13 remained free of bleeding(group B).Six deaths were recorded:Three due to major bleeding,one from thrombotic stroke,and two unrelated to coagulopathy.EXTEM clotting time(CT)-post was the only parameter that significantly differed between group A and group B(P=0.013).Each 1-second increase in CT-post was linked to an 8%higher likelihood of a bleeding event(odds ratio=1.08,95%confidence interval:1.0-1.17;P=0.048).A significant progressive increase was observed with the drug’s trough and peak levels(P<0.05)across the four dosing regimens but no significant relationship was found between CT and apixaban dose groups.CONCLUSION Early detection of bleeding risk in HD patients with NVAF on Apixaban maybe be effectively achieved through frequent monitoring using ROTEM EXTEM post CT,thereby helping to reduce associated morbidity.展开更多
Stent implantation has been a great advance in percutaneous coronary intervention （PCI）, decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regard...Stent implantation has been a great advance in percutaneous coronary intervention （PCI）, decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regardless of the stent type： bare-metal stent （BMS） and drug-eluting stent （DES）. According to the timing after initial PCI, stent thrombosis is considered as acute when occurring between 0 hour and 24 hours after stent implantation, subacute between 24 hours and 30 days,展开更多
文摘Stent implantation has greatly decreased the frequency of acute closure and restenosis after percutaneous coronary inter-vention (PCI) .But stent thrombosis continues to be observed in approximately 1% to 2% of unselected stent procedures and remains a devastating complication.Herein we present a case of subacute coronary stent thrombosis in a patient with anterior AMI treated with double antiplatelet drugs and low molecular weight heparin.
文摘BACKGROUND The use of apixaban in chronic hemodialysis(HD)patients for non-valvular atrial fibrillation(NVAF)is still controversial regarding benefit of stroke protection vs risk of bleeding.Rotational thromboelastometry(ROTEM)is a point of care method that evaluates clot formation in whole blood and has been used as an evaluation tool for bleeding risk assessment in non-HD apixaban users.AIM To determine whether bleeding risk can be predicted using ROTEM activated with tissue factor(EXTEM)in HD patients receiving apixaban for NVAF.METHODS Nineteen HD patients with NVAF treated with apixaban for at least 8 days were enrolled.Four dosing regimens were recorded as prescribed by their physician,from 2.5 mg once daily on a non-dialysis day to 5 mg twice daily.Standard coagulation tests,along with ROTEM and apixaban drug levels(using liquid anti-Xa assay)were performed once on a non-dialysis day before and two hours after apixaban morning pill administration.Patients were subsequently monitored for thrombotic/bleeding events and all-cause mortality.RESULTS Over a median follow-up period of 36 months,six patients experienced a bleeding event(group A)and 13 remained free of bleeding(group B).Six deaths were recorded:Three due to major bleeding,one from thrombotic stroke,and two unrelated to coagulopathy.EXTEM clotting time(CT)-post was the only parameter that significantly differed between group A and group B(P=0.013).Each 1-second increase in CT-post was linked to an 8%higher likelihood of a bleeding event(odds ratio=1.08,95%confidence interval:1.0-1.17;P=0.048).A significant progressive increase was observed with the drug’s trough and peak levels(P<0.05)across the four dosing regimens but no significant relationship was found between CT and apixaban dose groups.CONCLUSION Early detection of bleeding risk in HD patients with NVAF on Apixaban maybe be effectively achieved through frequent monitoring using ROTEM EXTEM post CT,thereby helping to reduce associated morbidity.
文摘Stent implantation has been a great advance in percutaneous coronary intervention （PCI）, decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regardless of the stent type： bare-metal stent （BMS） and drug-eluting stent （DES）. According to the timing after initial PCI, stent thrombosis is considered as acute when occurring between 0 hour and 24 hours after stent implantation, subacute between 24 hours and 30 days,
