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首页> 外文期刊>European Heart Journal - Case Reports >Percutaneous coronary intervention in a patient with heparin resistance due to essential thrombocythaemia: a case report
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Percutaneous coronary intervention in a patient with heparin resistance due to essential thrombocythaemia: a case report

机译:由于基本血小板血症引起的肝素抗性患者的经皮冠状动脉干预:案例报告

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Background Coronary artery disease is uncommon in patients with essential thrombocythaemia (ET); therefore, no treatment strategies have been established. Case summary A 68-year-old man visited our hospital with worsening effort angina complicated with ET. Coronary angiography (CAG) revealed moderate stenosis of the left main trunk and left anterior descending artery (LAD). We planned to perform percutaneous coronary intervention (PCI) only after the patient’s platelet count had fallen below 600 000/μL. Platelet factor 4 levels were markedly elevated (355.0?ng/mL; the normal range is 20?ng/mL). We observed a de novo lesion in the proximal left circumflex artery and stenosis progression in the LAD at the time of the PCI, neither of which had been detected at the previous CAG. During the PCI procedure, argatroban was infused to maintain the activated clotting time (ACT) above 250?s. The PCI was performed successfully without any complications. Follow-up CAG showed no restenosis, and no bleeding complications were observed during the course. Discussion In patients with ET, it may be useful to measure platelet factor 4 before PCI and to monitor ACT during the procedure. When heparin resistance is suspected based on blood coagulation tests, infusion of direct thrombin inhibitor during PCI may be considered, with anticoagulation monitoring by ACT.
机译:背景技术冠状动脉疾病在必需血小板血症(ET)的患者中罕见;因此,没有建立治疗策略。案例摘要一名68岁的男子访问了我们的医院,努力使努力变得恶化。冠状动脉血管造影(CAG)显示左主干和左侧下降动脉(LAD)的中等狭窄。我们计划仅在患者的血小板计数下降到600000 /μL以下后进行经皮冠状动脉干预(PCI)。血小板因子4水平明显升高(355.0≤ng/ ml;正常范围是&20≤ng/ ml)。在PCI时,我们观察到近端左左环动脉和狭窄进展中的近端左左环动脉和狭窄进展,既不是在先前的CAG中检测到的。在PCI程序期间,ArgatroBan注入以维持最活化的凝血时间(ACT)以上250秒。 PCI成功进行,没有任何并发​​症。随访CAG显示没有再狭窄,在课程中没有观察到出血并发症。讨论ET的患者,在PCI之前测量血小板因子4并在程序期间监测该行为可能有用。当基于血液凝固试验怀疑肝素抗性时,可以考虑在PCI期间引入直接凝血酶抑制剂,通过ACT抗凝监测。

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