Gorog Diana A, Saraf Smriti, Markides Vias
East & North Hertfordshire NHS Trust, Cardiology, Queen Elizabeth II Hospital, Welwyn Garden City AL7 4HQ, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0983. Epub 2009 Apr 14.
Acute stent thrombosis remains one of the most important concerns in clinical cardiology. The mechanism is not fully understood but a prothrombotic state is a key component. We describe a case of acute stent thrombosis, within an hour of rescue angioplasty, despite use of full dose fibrinolytic (reteplase) and antiplatelet therapy (aspirin and clopidogrel). Risk of acute stent thrombosis was predicted an hour earlier, when the patient was clinically well, by a novel near-patient test of thrombotic and thrombolytic status (in vitro). Subsequent stent thrombosis was visualised angiographically (in vivo) and confirmed by extraction of the thrombus (ex vivo). The near-patient test sensitively detected reversal of the prothrombotic state after abciximab treatment. We believe this is the first description of the clinical use of a near-patient test within the cardiac catheterisation laboratory to predict risk of imminent stent thrombosis.
急性支架血栓形成仍然是临床心脏病学中最重要的问题之一。其机制尚未完全明了，但血栓前状态是一个关键因素。我们描述了一例急性支架血栓形成的病例，尽管使用了全剂量纤溶药物（瑞替普酶）和抗血小板治疗（阿司匹林和氯吡格雷），但在抢救性血管成形术一小时内仍发生了血栓形成。在患者临床状况良好时，通过一项新型的血栓形成和溶栓状态床旁检测（体外检测）提前一小时预测了急性支架血栓形成的风险。随后通过血管造影（体内检测）观察到了支架血栓形成，并通过血栓提取（离体检测）得以证实。床旁检测灵敏地检测到了阿昔单抗治疗后血栓前状态的逆转。我们认为这是首次描述在心脏导管实验室中使用床旁检测来预测即将发生的支架血栓形成风险的临床应用。
