The Journal of invasive cardiology
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Dual antiplatelet therapy of aspirin and a thienopyridine is the standard of care following coronary stenting. Patients who are on chronic warfarin therapy and receive a coronary stent need to be treated with the triple therapy of aspirin, clopidogrel and warfarin; however, the bleeding risk in these patients is unknown. To evaluate the bleeding risk in patients requiring chronic warfarin therapy and undergoing stent implantation, we compared 107 consecutive patients on chronic warfarin therapy who underwent coronary stenting and were discharged on aspirin, clopidogrel and warfarin to 107 contemporary patients who were treated with aspirin and clopidogrel. ⋯ In the triple therapy group, the international normalized ratio or aspirin dosage did not influence the bleeding risk. In patients requiring warfarin therapy, the addition of dual antiplatelet therapy is associated with an approximately 7% major bleeding risk. Thus, novel regimens are needed to reduce the bleeding risk.
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Serious complications after percutaneous atrial septal abnormality closure are uncommon. We present a case of patent foramen ovale closure with early mobilization of the device and asymptomatic embolization into the descending aorta without sequels. Percutaneous retrieval of the device was successful down to the femoral artery from where it was extracted surgically.
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Case Reports
Mechanical reperfusion during acute myocardial infarction in a patient with dextrocardia.
Mechanical reperfusion is the preferred treatment for acute ST-elevation myocardial infarction, we describe a case of successful primary angioplasty and stenting in a patient with dextrocardia and situs inversus. Dextrocardia with complete situs inversus is a rare condition, occurring in about 2 in 10,000 live births. ⋯ There have been a few reports of percutaneous coronary intervention in these patients. We describe a case of primary angioplasty and stenting in a patient with dextrocardia and situs inversus and the electrocardiographic correlation of successful myocardial reperfusion.
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Case Reports
Fibromuscular dysplasia and acute myocardial infarction: evidence for a unique clinical and angiographic pattern.
Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic disease of the small- to medium-sized vessels that primarily affects young females in their second to fourth decades of life. Typically, FMD involves the renal and extracranial arteries, but at autopsy, it has also been reported to affect the coronary arteries. However, its association with acute coronary syndromes is not yet well recognized. We describe three cases of FMD that presented with an acute myocardial infarction as the initial manifestation and discuss a specific pattern found in all cases as well as the possible patholophysiologic mechanism responsible for the acute coronary syndrome.
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Automobile airbags have been universally installed to save lives in motor vehicle accidents, but have also been linked with facial and thoracic burns and chest trauma during rapid deployment. Blunt trauma to the chest may result in electrical and mechanical injuries to the heart and great vessels. ⋯ Although mechanical complications resulting from airbag injury have been reported in the past, this is the first report of an acute thrombotic coronary occlusion triggered by the rapid airbag deployment. The case underscores the importance of systematic clinical evaluation to guide management in patients with confounding clinical presentation.