Prolonged use of eptifibatide as a bridge to maintain drug-eluting stent patency in a patient receiving extracorporeal membrane oxygenation
| العنوان: | Prolonged use of eptifibatide as a bridge to maintain drug-eluting stent patency in a patient receiving extracorporeal membrane oxygenation |
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| المؤلفون: | Allison Bohlmann, Robert J. March, Payal Gurnani |
| المصدر: | Perfusion. 33:699-703 |
| بيانات النشر: | SAGE Publications, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Adult, Male, Cardiovascular event, Marfan syndrome, medicine.medical_specialty, medicine.medical_treatment, Eptifibatide, 030204 cardiovascular system & hematology, Bridge (interpersonal), Marfan Syndrome, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Internal medicine, Extracorporeal membrane oxygenation, Humans, Medicine, Radiology, Nuclear Medicine and imaging, In patient, Advanced and Specialized Nursing, business.industry, Drug-Eluting Stents, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Cardiac surgery, surgical procedures, operative, Drug-eluting stent, Cardiology, Cardiology and Cardiovascular Medicine, business, Safety Research, medicine.drug |
| الوصف: | Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge to cardiac recovery in patients following a major cardiac event. There is a lack of literature surrounding prolonged use of eptifibatide and optimal dosing during ECMO. This case report describes our experience with extended durations and standard dosing of eptifibatide in the setting of ECMO. Case: A 40-year-old male with a history of Marfan’s syndrome, aortic root and ascending aortic aneurysm status post a modified Bentall with a St. Jude mechanical aortic valve conduit and hemi-Cabrol with a Dacron graft to the left main coronary artery presented with exertional chest pain and was found to have an anastomotic narrowing to the left main which occluded while awaiting surgical revision. A rescue percutaneous coronary intervention at the anastomotic site was performed. Due to hemodynamic instability, he was placed on femoral VA-ECMO. The patient was started on anticoagulation for the ECMO circuit and eptifibatide to maintain stent patency. The patient experienced several bleeding episodes for which he received supportive care, endoscopic intervention and left gastric artery embolization. Eptifibatide was maintained at standard dosing and the heparin infusion was withheld. A coronary angiogram revealed no thrombus within the Cabrol graft a patent stent previously placed at the site of the distal graft-coronary anastomosis. The patient was decannulated from ECMO and underwent coronary artery bypass grafting and division of the hemi-Cabrol graft. Conclusion: While eptifibatide was effective in maintaining stent patency, our patient experienced several bleeding episodes during ECMO. Thus, the risks and benefits of concurrent antiplatelet and anticoagulant therapy must be appropriately weighed in this patient population. Additionally, as the need for dual antiplatelet therapy due to coronary stent implantation is increasing, further studies are needed to validate optimal dosing of eptifibatide in patients at a high risk of bleeding during ECMO. |
| تدمد: | 1477-111X 0267-6591 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f54585b5781d67e599fb877f62a5e19f https://doi.org/10.1177/0267659118780802 |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....f54585b5781d67e599fb877f62a5e19f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1477111X 02676591 |
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