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2018, vol. 37, br. 1, str. 21-23
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Fatalno intracerebralno krvarenje na dvojnoj antitrombocitnoj terapiji kod pacijenta sa infarktom miokarda bez ST elevacije koji je lečen urgentnom perkutanom koronarnom intervencijom
Fatal intracerebral haemorrhage on dual antiplatelet therapy in patient with myocardial infarction without ST elevation treated with urgent percutaneous coronary intervention: Case report
aVojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd bVojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
e-adresa: marijans74@gmail.com
Sažetak
Po važećim smernicama za upotrebu dvojne antiagregacione terapije u pacijenata sa infarktom miokarda bez ST elevacije (NSTEMI) primena dvojne antiagregacione terapije-ASA i ticagrelora se preporučuje (klasa I nivo dokaza B). Prikazujemo slučaj uspešne urgentne perkutane koronarne intervencije ( hitna PCI) kod pacijenta sa infarktom miokarda bez ST elevacije , koji je dobio udarnu dozu ticagrelora nakon učinjene koronarografije.Verifikovana je subtotalna stenoza desne koronarne arterije i učinjena implantacija stenta. Naš slučaj je pokazao primenu 2015. ESC smernica za primenu dvojne antiagregacione terapije u pacijenata sa NSTEMI. Procedura je bila uspešna, bez periproceduralnih komplikacija ali je oko 22 sata sledećeg dana došlo do fatalnog intrakranijalnog krvarenja a 48 sati od intervencije i do letalnog ishoda.
Abstract
According to valid guidelines for the use of dual antiplatelet therapy in patients with myocardial infarction without ST elevation (NSTEMI), the use of dual antiplatelet therapy -ASA and ticagrelor is recommended (class I level of evidence B). We report a case of a successful early percutaneous coronary intervention (early PCI) in a patient with a myocardial infarction without ST elevation which received a loding dose ticagrelor after coronary angiography. We found the subtotal stenosis of the right coronary artery and stent implantation is performed.Our case showed implementation of 2015. ESC guidelines on dual antiplatelet therapy in patient with NSTEMI. The procedure was successful without periprocedural complication.but at 22 hours next day patient was intracranial hemorrhage and 48 after patient died.
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Reference
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Roffi, M., Patrono, C., Collet, J., Mueller, C., Valgimigli, M., Andreotti, F., Bax, J.J., Borger, M.A., Brotons, C., Chew, D.P., Gencer, B., Hasenfuss, G., Kjeldsen, K., Lancellotti, P. (2015) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 37(3): 267-315
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Valgimigli, M., Bueno, H., Byrne, R.A., i dr. (2018) 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the Euro. Eur Heart J, 39: 213-254
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