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通过停用双联抗血小板治疗并实施主动脉内球囊反搏来控制经皮冠状动脉介入术后急性期肠道出血

Control of acute phase intestinal bleeding after percutaneous coronary intervention by discontinuing dual antiplatelet therapy and implementing intra-aortic balloon pumping.

作者信息

Nakabayashi Keisuke, Higashitani Michiaki

机构信息

Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.

Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.

出版信息

J Cardiol Cases. 2015 Jan 22;11(4):113-116. doi: 10.1016/j.jccase.2014.12.004. eCollection 2015 Apr.

Abstract

Aspirin's efficacy for the prevention of secondary vascular disease is well supported. However, more attention should be given to its side effects, especially gastrointestinal injury. A 62-year-old man suffered acute myocardial infarction of the left main trunk. Although a percutaneous coronary intervention, using a bare metal stent, was successful, intractable in-bowel bleeding developed. To control the bleeding, we discontinued dual antiplatelet therapy during the acute phase, and used intra-aortic balloon pumping to provide sufficient coronary flow to prevent stent thrombosis. This strategy controlled intestinal bleeding without any thrombotic complications, indicating that intra-aortic balloon pumping is effective for preventing stent thrombosis. < Aspirin often causes bleeding complications, especially in the gastrointestinal tract. We experienced a case with severe intestinal bleeding of unknown origin during the acute phase after percutaneous coronary intervention for acute myocardial infarction. The dual antiplatelet therapy was necessarily stopped, which could have resulted in stent thrombosis. We used intra-aortic balloon pumping to prevent the stent thrombosis through coronary flow augmentation.>.

摘要

阿司匹林预防继发性血管疾病的疗效有充分依据。然而,应更多关注其副作用,尤其是胃肠道损伤。一名62岁男性发生左主干急性心肌梗死。尽管使用裸金属支架进行经皮冠状动脉介入治疗成功,但出现了难以控制的肠道出血。为控制出血,我们在急性期停用了双联抗血小板治疗,并使用主动脉内球囊泵以提供足够的冠状动脉血流来预防支架血栓形成。该策略控制了肠道出血且无任何血栓形成并发症,表明主动脉内球囊泵对预防支架血栓形成有效。<阿司匹林常引起出血并发症,尤其是在胃肠道。我们遇到一例在急性心肌梗死经皮冠状动脉介入治疗后的急性期出现不明原因严重肠道出血的病例。双联抗血小板治疗不得不停止,这可能导致支架血栓形成。我们使用主动脉内球囊泵通过增加冠状动脉血流来预防支架血栓形成。>

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