ABSTRACT
We describe the case of a patient who had suspected myocardial ischemia, showed normal findings on multiple perfusion scans, and showed isolated cardiac sarcoidosis on 18F-FDG-PET. Also discussed are the diagnosis and the monitoring of disease response using imaging follow-up.
Subject(s)
Cardiomyopathies/diagnostic imaging , Fluorodeoxyglucose F18 , Positron-Emission Tomography/methods , Sarcoidosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers. Here we describe two patients that developed in-stent thrombosis when switching from ticagrelor to clopidogrel using a 300 mg clopidogrel loading dose. Both patients presented with ST elevation myocardial infarction and underwent stent placement but then developed in-stent thrombosis 48 hours after switching from ticagrelor to clopidogrel. These cases illustrate the severe consequences of suboptimal platelet inhibition and the need for prospective trials thoroughly powered to assess clinical outcomes in order to determine the most appropriate strategy when switching from ticagrelor to clopidogrel.
