Avtor/Urednik		Godec, Manca; Sinkovič, Andreja
Naslov		Gastrointestinal bleeding after primary percutaneous coronary intervention in acute coronary syndrome with ST-elevation on electrocardiogram - case report and review of literature
Prevedeni naslov		Krvavitev iz prebavil po primarni perkutani koronarni intervenciji zaradi akutnega koronarnega sindroma z elevacijo ST segmenta v elektrokardiogramu - prikaz primera in pregled literature
Tip		članek
Vir		Slov Kardiol
Vol. in št.		Letnik 3, št. 2
Leto izdaje		2006
Obseg		str. 164-7
Jezik		eng
Abstrakt		In patients with acute coronary syndrome with persistent ST-segment elevation on electrocardiogram (STEMI), primary percutaneous coronary intervention (PCI) is the most efficient and safest treatment when combined with inhibitors of platelet aggregation and heparin. Bleeding, including gastrointestinal, is among the most feared complications. A case is presented of a patient with STEMI treated with primary PCI combined with aspirin, clopidogrel, glycoprotein (GP) receptor blockers Ilb/Illa and heparin who started to bleed from the upper gastrointestinal tract during the first few hours of treatment, despite protection with a proton pump inhibitor. Soon after the acute bleeding episode, the patient experienced cardiac arrest due to asystole. After short and successful resuscitation, the patient regained consciousness and spontaneous circulation (ROSC). Endoscopic hemostasis was not performed as the bleeding spontaneously ceased. Blood transfusion was not necessary, only temporarily IV treatment with octreotide and omeprasole. Treatment with inhibitors of platelet aggregation and heparin was temporarily stopped. After 48 hours clopidogrel and heparin therapy was restarted and treatment with angiotensin converting enzyme inhibitor and statin was initiated. The patient was transferred to his local hospital after a few days and was later discharged home in Killip class I-II. It is concluded that in STEMI patients it is important to prevent any possible bleeding by administering a proton pump inhibitor in a dosage of over 40 mg IV, especially in the case of prior gastrointestinal bleeding and ulcer disease. In the case of an acute bleeding episode, temporary treatment with an IV proton pump inhibitor, octreotide and tranexamic acid seems effective.
Izvleček		Pri akutnem koronarnem sindromu s trajnim dvigom veznice ST v EKG (STEMI) je primarna perkutana koronarna intervencija (PKI) najučinkovitejši in najvarnejši način zdravljenja, čeprav je kombinirana z različnimi antiagregacijskimi sredstvi in s heparinom. Najpomembnejši možni zapteti so predvsem krvavitve, vključno krvavitve iz prebavne cevi. Prikazujemo primer bolnika s STEMI, zdravljenega s primarno PKI, kombinirano z aspirinom, klipodogrelom, zaviralcem GP receptorjev Ilb/Illa in heparinom, ki je zakrvavel v prvih urah zdravljenja iz zgornjega dela prebavne cevi kljub zaščiti z blokatorjem protonske črpalke, takoj za tem pa je utrpel nenadno srčno smrt zaradi asistolije. Po kratkotrajnem uspešnem oživljanju se je vzpostavila zavest, tipen puts in merljiv tlak. Endoskopska hemostaza ni bila opravljena, ker se je krvavitev spontano ustavila. Transfuzija krvi ni bila potrebna, ampak le prehodno zdravljenje z iv. infuzijo analoga sandostatina - oktreotida in nadaljevanje zdravljenja z omeprazolom iv. Začasno smo prekinili zdravljenje z antiagregacijskimi sredstvi in heparinom. Po 48 urah smo uvedli zaviralec konvertaze s statinom in ponovno klopidogrel in enoksaparin. Zaključki so, da je pri bolnikih s STEMI pomembno preprečiti vsako krvavitev, če je to le mogoče. Za preprečevanje pojava akutne krvavitve iz prebavil je pri pri bolnikih s STEMI zgodnja uporaba blokatorja protonske črpalke smiselna, posebno v primeru predhodnih gastrointestinalnih krvavitev ali ulkusne bolezni.
Deskriptorji		CORONARY DISEASE ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY GASTROINTESTINAL HEMORRHAGE ELECTROCARDIOGRAPHY HEPARIN AGED PLATELET AGGREGATION INHIBITORS