Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
Correspondence
Corresponding author. Department of Internal Medicine I Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic. Tel.: +421 907 612 943, +421 43 4203 820.
Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
Correspondence
Corresponding author. Department of Internal Medicine I Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic. Tel.: +421 907 612 943, +421 43 4203 820.
National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Figures
Fig. 1
Urgent coronary angiography in patient with acute STEMI showing an acute subocclusion of LAD and angiography after pPCI on LAD with implantation of BMS.
Fig. 2
Twelve lead ECG record with ST-segment elevation suggestive of acute re-STEMI of anterior wall.
Fig. 3
Urgent coronary angiography in patient with acute re-STEMI of anterior wall showing an acute stent thrombosis of LAD and angiography after repeated pPCI on LAD with catheter thromboextraction and implantation of 2 BMS.
Abstract
Stent thrombosis is a morbid complication after percutaneous coronary intervention. Dual antiplatelet therapy significantly reduces stent thrombosis risk and forms currently the basis in acute ST elevation myocardial infarction pharmacologic treatment. The introduction of clopidogrel has made a major advance in the acute coronary syndrome treatment. However, there is growing evidence about failure in antiplatelet response after clopidogrel, which may lead to subsequent risk of future thrombotic events. The antiplatelet inhibitory effect of clopidogrel varies widely among individuals. High on-treatment platelet reactivity has been repeatedly associated with a hazard for cardiovascular events, including stent thrombosis. Laboratory monitoring of antiplatelet therapy efficacy may help identify patients with insufficient antiplatelet response. Prasugrel therapy was repeatedly described as an effective method to overcome clopidogrel resistance. We report a case of diabetic patient in whom myocardial reinfarction due to stent thrombosis developed. Clopidogrel resistance was detected in this patient using light transmission aggregometry and vasodilator-stimulated phosphoprotein phosphorylation assessment. After prasugrel administration, no other ischemic event occurred, and patient was released to outpatient care in good general condition.
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☆This study was supported by project APVV (Slovak Research and Development Agency) 0222-11 , by project CEPV II [IT Monitoring System for Structural funds and Cohesion Fund (ITMS) 26220120036 ], which is cofinanced from European Commission (EC) sources and by research project of Slovak Society of Cardiology 2012-2015 and by Young Heart Science organization.
☆☆Conflict of interest: The authors have no conflict of interest to declare.
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