ABSTRACT
Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood loss. Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor's hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.
Subject(s)
Chimerism , Transfusion Reaction , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/therapy , Anemia/epidemiology , Anemia/etiology , Anemia/physiopathology , Anemia/therapy , Angioplasty, Balloon, Coronary/adverse effects , Blood Preservation , Blood Transfusion/statistics & numerical data , Cell Survival , Clinical Trials as Topic/statistics & numerical data , Cytokines/metabolism , Female , Fetomaternal Transfusion , Fibrinolytic Agents/adverse effects , Fibrinolytic Agents/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Hemorrhage/etiology , Hemorrhage/physiopathology , Humans , Incidence , Leukocytes/cytology , Leukocytes/immunology , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/therapeutic use , Pregnancy , Treatment OutcomeABSTRACT
Although percutaneous coronary intervention restores optimal epicardial blood flow in most cases, abnormal myocardial perfusion may still persist. This might be as a result of macro and microembolization, neutrophil plugging, vasoconstriction, myocyte contracture, local intracellular and interstitial edema, intramural haemorrhage, and endothelial blistering. Local delivery of intracoronary pharmacotherapy via the coronary arteries may increase local drug concentration several fold, and may improve drug efficacy. Several pharmacological agents such as adenosine, calcium channel blockers, alpha blockers, beta2 receptor activators, vasodilators, antithrombotics, and antiplatelet agents have been used to treat coronary microvascular dysfunction. This article reviews the results of trials of intracoronary pharmacotherapy to date.
