J Transcat Intervent.2020;28:eA20200005.
Deferred stent implantation in patients with acute coronary syndromes and thrombus-containing lesion. New indication for direct oral anticoagulants?
Luis Alfredo García-Nielsen
, Rafael Feldman
, Gerardo Rafael Padilla
, Myriam Susana Espinosa
, Pablo Pillin
DOI: 10.31160/JOTCI202028A20200005
ABSTRACT
Background
When stents are implanted in the thrombotic environment, they may cause coronary emboli, with increased risk of no-reflow and clinical complications. The aim of this study is to evaluate the impact of delayed stenting in patients with acute coronary syndromes and thrombus-laden coronary arteries using the direct oral anticoagulant apixaban in combination to dual antiplatelet therapy.
Methods
We included 11 consecutive patients. After first coronariography, patients received treatment with aspirin, clopidogrel and apixaban for 7 days. Another angiography/intervention was planned and stent implantation performed in cases with a residual stenosis diameter >30%.
Results
Most participants were male (80%). All were diabetic. Multivessel disease was present in 20% of cases. All patients remained clinically stable between the first and second procedure. Stent implantation was not required in two patients. In the remaining nine, the mean residual stenosis and the median thrombus burden was visually smaller, and a drug eluting stent was implanted. There was no phenomenon of no-reflow/slow-flow after stent deployment, with blush grade 3 in all of them.
Conclusion
Apixaban in association with dual antiplatelet therapy has shown to be effective to reduce thrombus burden and mechanical complications of stent deployment, when coronary thrombus is angiographically identifiable.
Keywords: Apixaban; Coronary thrombosis; Dilatation, pathologic
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