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Antiplatelet therapy for patients with stable ischemic heart disease and baseline thrombocytopenia: Ask the hematologist

机译:稳定型缺血性心脏病和基线血小板减少症患者的抗血小板治疗:请血液科医生

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摘要

Baseline thrombocytopenia (TP) is relatively common in patients referred for percutaneous coronary intervention (PCI). Its detection may have implications for long-term antiplatelet medication prescription and adherence. The aim of this article is to review several practical aspects in managing patients with baseline TP and stable coronary artery disease (CAD). Moving from two clinical cases, we tried to picture cardiological scenarios associated with baseline TP and to provide flow charts for patient's management which take into consideration both the cardiological and the hematological conditions. TP in patients with stable CAD on antiplatelet treatment may follow diverse clinical courses depending upon TP inferred etiology, baseline degree of thrombocytopenia and its time course as outlined by previous complete blood counts, when available. Evaluation of these three parameters may guide the planning of further patient work-up and the choice of the most appropriate cardiological treatment (medical, invasive with stent implantation or coronary artery bypass). A multidisciplinary evaluation comprehensive of hematological counseling is also recommended in these patients before planning prolonged dual anti-platelet therapy.
机译:基线血小板减少症(TP)在经皮冠状动脉介入治疗(PCI)的患者中相对常见。其检测可能对长期抗血小板药物处方和依从性有影响。本文的目的是回顾在管理基线TP和稳定冠状动脉疾病(CAD)患者方面的几个实际方面。从两个临床案例出发,我们试图描绘与基线TP相关的心脏病情况,并为患者的治疗提供流程图,同时考虑到心脏病和血液学状况。抗血小板治疗稳定的CAD患者的TP可能会遵循不同的临床过程,具体取决于TP推断的病因,血小板减少症的基线程度以及其先前的全血细胞计数概述的时间过程(如果有)。对这三个参数的评估可以指导进一步患者检查的计划以及最合适的心脏病治疗(医学,支架植入或冠状动脉搭桥术)的选择。在计划延长双重抗血小板治疗之前,还建议对这些患者进行多学科的血液学咨询综合评估。

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