A case of myocardial infarction caused by obstruction of a drug-eluting stent during the perioperative period

JA Clinical Reports
Hiroaki ToyamaMasanori Yamauchi

Abstract

We report a patient who developed drug-eluting stent (DES) thrombosis induced by discontinuation of dual antiplatelet therapy (DAPT) and subsequently had a massive surgical site bleed caused by restarting heparin and DAPT during the perioperative period. An 85-year-old man visited a local hospital owing to complaints dyspnea. He was diagnosed with laryngeal cancer and was scheduled for a total laryngectomy. Preoperative examinations showed an anteroseptal myocardial infarction. A DES was placed at segment 6 of the coronary artery and DAPT was initiated 27 days before surgery. After admission to our hospital, DAPT was replaced with unfractionated heparin. On the operation day, heparin was discontinued, and a tracheotomy, total laryngectomy and right hemi-thyroidectomy were performed. While recovering from anesthesia, ischemic ST elevation appeared. Cardiac catheterization revealed complete obstruction of the DES by a white thrombus. After recanalization, heparin and DAPT were restarted, and bleeding occurred. The next day, total blood loss was 2755 mL and surgical hemostasis was performed. Because his serum creatine kinase value was elevated at the cessation of heparin, anticoagulation by unfractionated heparin could not have pr...Continue Reading

References

Mar 24, 2011·Circulation Journal : Official Journal of the Japanese Circulation Society·UNKNOWN JCS Joint Working Group
Mar 8, 2012·Circulation. Cardiovascular Interventions·Akihiro TokushigeUNKNOWN CREDO-Kyoto PCI/CABG registry cohort-2 investigators
Oct 9, 2013·JAMA : the Journal of the American Medical Association·Mary T HawnThomas M Maddox

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