Ginder Curtis R, Suero-Abreu Giselle A, Ghumman Saad S, Bergmark Brian A, Arnaout Omar, Giugliano Robert P
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cardiol Ther. 2024 Jun;13(2):443-452. doi: 10.1007/s40119-024-00356-7. Epub 2024 Mar 27.
The management of perioperative acute myocardial infarction (AMI) following oncologic neurosurgery requires balancing competing risks of myocardial ischemia and postoperative bleeding. There are limited human data to establish the safest timing of antiplatelet or anticoagulation therapy following neurosurgical procedures. For patients with malignancy experiencing AMI in the acute postoperative period, staged percutaneous coronary intervention (PCI) with upfront coronary aspiration thrombectomy followed by delayed completion PCI may offer an opportunity for myocardial salvage while minimizing postoperative bleeding risks. CYP2C19 genotyping and platelet aggregation studies can help confirm adequate platelet inhibition once antiplatelet therapy is resumed.
肿瘤神经外科手术后围手术期急性心肌梗死（AMI）的管理需要平衡心肌缺血和术后出血的相互竞争风险。关于神经外科手术后抗血小板或抗凝治疗的最安全时机，人类数据有限。对于术后急性期发生AMI的恶性肿瘤患者，分期经皮冠状动脉介入治疗（PCI），先行冠状动脉抽吸血栓切除术，然后延迟完成PCI，可能为心肌挽救提供机会，同时将术后出血风险降至最低。一旦恢复抗血小板治疗，CYP2C19基因分型和血小板聚集研究有助于确认血小板抑制是否充分。
