Importancia del tiempo de suspensión del uso combinado de aspirina y clopidogrel en pacientes sometidos a cirugía de revascularización coronaria / Importance of the time for stopping the combined use of aspirin and clopidogrel in patients undergoing coronary artery by-pass graft surgery

The combined use of aspirin and clopidogrel is the standard of care for patients with acute coronary syndromes. The risk for perioperative bleeding is considerably increased after coronary artery by-pass graft surgery (CABG). This study was designed to evaluate the effect of antiplatelet therapy on perioperative CABG outcome. We studied 49 consecutive patients undergoing first time CABG, and compared two groups: Group A, patients who stopped antiplatelet treatment at least 6 days before surgery, and group B, those who received antiplatelet therapy within 5 days before surgery or did not suspended therapy. The groups were comparable in their demographic characteristics, manifestations of disease, perioperative medication use and the characteristics of surgery. There was a non significant tendency for more cardiovascular complications (primary cardiovascular endpoint) in the group that stopped antiplatelet therapy 6 or more days before surgery (Group A 12%, group B 8%; p = 0.923). The bleeding endpoint was significantly higher in group B, that remained on antiplatelet therapy within 5 days before surgery (Group A 4%, group B 29%; p = 0.023), as well as the need for transfusion. We concluded that the combined use of aspirin and clopidogrel before CABG increases postoperative bleeding and morbidity; there was no definitive difference in the cardiovascular outcome.

Taponamiento cardiaco por metastasis pericardica. / Cardiac tamponade due to pericardial metastasis

Se presenta el caso de un paciente masculino joven, con diagnostico de taponamiento cardiaco consecutivo a metastasis pericardicas de adenocarcinoma broncogeno. Se revisan los metodos diagnosticos mas utiles, entre los cuales destaca la citologia del derrame periocardico. Se enfatiza el hecho de que los tumores malignos originarios del pulmon, son los que mas frecuentemente invaden corazon, con diferente expresion clinica segun el sitio involucrado. Se hace una exposicion detallada de las vias de drenaje linfatico, mismas que explican adecuadamente el desarrollo de liquido hemorragico dentro del saco pericardico y se comprueba que este tipo de patologia, es una causa relativamente rara de taponamiento cardiaco, pero que debe tenerse en mente para un diagnostico precoz que puede ser valiosa ayuda