ABSTRACT
Platelet glycoprotein IIb-IIIa antagonists reduce cardiac events in acute coronary syndromes (ACSs), but their use is limited during coronary artery bypass grafting (CABG) because of bleeding concerns. Patients with ACS, however, are at increased risk for cardiac events after CABG. The use of short-acting glycoprotein IIbIIIa inhibitor eptifibatide in patients with ACS undergoing CABG was investigated. Fifteen patients with ACS and undergoing CABG with cardiopulmonary bypass were enrolled. One withdrew before surgery. Patients received heparin and eptifibatide preoperatively. Eptifibatide concentration and receptor occupancy (RO) at termination of infusion were similar in the two groups. Immediately before surgery, eptifibatide levels in the 2-hour group were twice that in the 4-hour group, and platelet RO was higher. Cessation of eptifibatide 4 hours before surgery results in less bleeding and transfusions than 2 hours before surgery. The optimal balance between bleeding and platelet inhibition is approximately 60% platelet RO. Further investigation of upstream therapy should target this threshold.
Subject(s)
Cardiopulmonary Bypass/methods , Coronary Artery Bypass/methods , Peptides/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Aged , Eptifibatide , Erythrocyte Transfusion/statistics & numerical data , Female , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , Infusions, Intravenous , Male , Middle Aged , Peptides/administration & dosage , Peptides/blood , Platelet Aggregation Inhibitors/administration & dosage , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Platelet Transfusion/statistics & numerical data , Postoperative Complications/prevention & control , Preoperative Care/methods , Treatment OutcomeABSTRACT
The use of antiplatelet agents in the management of patients undergoing percutaneous coronary interventions involves the administration of aspirin, thienopyridines, and in high-risk patients, GPIIb-IIIa antagonists. Drug-eluting stents now account for greater than 50% of stenting procedures. This review focuses on the limited available data describing the use of antiplatelet agents in patients undergoing drug-eluting stent implantation.
Subject(s)
Aspirin/therapeutic use , Coronary Stenosis/therapy , Platelet Aggregation Inhibitors/therapeutic use , Pyridines/therapeutic use , Stents , Coronary Stenosis/drug therapy , Humans , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitorsABSTRACT
We describe a case of carotid artery restenosis following carotid artery stenting for treatment of post-endarterectomy stenosis. The goal is to highlight the risk of recurrent restenosis following endarterectomy. In this case report, we describe the use of cutting balloon therapy as a reasonable alternative to repeat surgical revascularization.
