Assuntos
Angioplastia Coronária com Balão , Anticorpos Monoclonais/uso terapêutico , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Infarto do Miocárdio/terapia , Stents , Terapia Trombolítica , Abciximab , Humanos , Infarto do Miocárdio/tratamento farmacológico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Falha de TratamentoRESUMO
We describe two cases of intracoronary vascular brachytherapy where bivalirudin (Angiomax), employed as an anticoagulant, led to abrupt vessel closure or threatened abrupt closure. Use of bivalirudin (Angiomax) during intracoronary brachytherapy may predispose to the formation of intracoronary thrombus, related to the reversible binding kinetics of the bivalirudin to thrombin, and resulting in recovery of thrombin functional activity during periods of prolonged stasis that occur during intracoronary brachytherapy. Intracoronary abciximab administration may be a useful strategy in resolving the acute closure, since abciximab administered early during the formation of thrombus has been shown to facilitate clot lysis.
Assuntos
Braquiterapia , Reestenose Coronária/etiologia , Vasos Coronários/fisiopatologia , Terapia com Hirudina/efeitos adversos , Hirudinas/análogos & derivados , Hirudinas/efeitos adversos , Fragmentos de Peptídeos/efeitos adversos , Proteínas Recombinantes/efeitos adversos , Trombina/antagonistas & inibidores , Abciximab , Doença Aguda , Idoso , Anticorpos Monoclonais/uso terapêutico , Angiografia Coronária , Reestenose Coronária/tratamento farmacológico , Reestenose Coronária/prevenção & controle , Feminino , Humanos , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Injeções , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Resultado do TratamentoRESUMO
A case of a 65-year-old woman presenting with delayed profound thrombocytopenia 7 days after the use of abciximab (ReoPro) in the setting of percutaneous coronary intervention is described. The patient had normal platelet counts for the first 24 hours after the use of abciximab (ReoPro). She presented with petechiae and profound thrombocytopenia 1 week later. The patient was treated successfully with a platelet transfusion and recovered uneventfully. Profound thrombocytopenia occurs acutely within the first few hours after abciximab (ReoPro) use, so this case was unique in that the profound thrombocytopenia presented 1 week after use of abciximab (ReoPro).
