Akkus Nuri I, Rajpal Saurabh, Agnani Sujata
Division of Cardiology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA.
J Invasive Cardiol. 2012 Feb;24(2):76-8.
Stent thrombosis is not unusual in a post-operative setting. Use of heparin, aspirin, clopidogrel, and glycoprotein (GP) IIb/IIIa inhibitors in this setting needs to be balanced because of the increased risk of perioperative bleeding. This is of special concern in neurosurgery, where postoperative mass effect from bleeding in a closed space is a serious risk. We describe a unique case of inferior and anterior ST-elevation myocardial infarction in cardiogenic shock during spinal surgery with acute, very late bare-metal stent (BMS) thrombosis in the left anterior descending coronary artery and simultaneous acute thrombotic occlusion of the right coronary artery, treated by primary percutaneous intervention, intra-aortic balloon pump (IABP) support and use of GP IIb/IIIa inhibitor in addition to clopidogrel, aspirin, and heparin with good surgical and cardiac outcome. This case report describes first time use of GP IIb/IIIa inhibitor and IABP with heparin, in a patient just after spinal surgery.
支架血栓形成在术后并不罕见。由于围手术期出血风险增加，在此情况下使用肝素、阿司匹林、氯吡格雷和糖蛋白（GP）IIb/IIIa抑制剂需要权衡。这在神经外科手术中尤为令人担忧，因为在封闭空间内出血导致的术后占位效应是一个严重风险。我们描述了一例独特病例，在脊柱手术期间发生心源性休克，伴有下壁和前壁ST段抬高型心肌梗死，左前降支冠状动脉发生急性、极晚期裸金属支架（BMS）血栓形成，同时右冠状动脉发生急性血栓闭塞，通过直接经皮介入治疗、主动脉内球囊泵（IABP）支持以及除氯吡格雷、阿司匹林和肝素外使用GP IIb/IIIa抑制剂，获得了良好的手术和心脏结局。本病例报告首次描述了在脊柱手术后患者中联合使用GP IIb/IIIa抑制剂、IABP和肝素的情况。
