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Published on: March 15, 2022

Intracoronary macrothrombus formation during percutaneous coronary intervention despite optimal activated clotting

George M Tadros1, Kevin Broder, Fouad Bachour

  • 1Division of Cardiology, University of Minnesota, Minneapolis, MN, USA.

Angiology
|December 6, 2005
PubMed

Insights

Intracoronary thrombus during percutaneous coronary intervention (PCI) can occur despite adequate anticoagulation. This case highlights macrothrombus formation during PCI even with bivalirudin and appropriate activated clotting time (ACT).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis

Background:

  • Intracoronary thrombus is a known complication of percutaneous coronary intervention (PCI), affecting approximately 6% of procedures.
  • Patients with acute ischemic syndromes or visible thrombus are at highest risk.
  • Intravenous unfractionated heparin (UFH), guided by activated clotting time (ACT), is the standard antithrombotic therapy during PCI.

Observation:

  • Bivalirudin, a direct thrombin inhibitor, has demonstrated reduced ischemic and vascular complications compared to UFH and glycoprotein IIb/IIIa inhibitors.
  • This report details a rare case of acute macrothrombus formation during PCI.
  • Adequate activated clotting time (ACT) was achieved with bivalirudin during the procedure.

Findings:

  • Despite using bivalirudin and maintaining an adequate ACT, acute macrothrombus formation occurred during PCI.
  • This challenges the assumption that standard anticoagulation protocols always prevent thrombus formation in high-risk PCI scenarios.

Implications:

  • This case underscores the potential for thrombotic complications even with advanced anticoagulation strategies like bivalirudin.
  • Further research may be needed to refine anticoagulation protocols for PCI in patients with high thrombotic risk.
  • Clinicians should remain vigilant for intracoronary thrombus formation during PCI, irrespective of the anticoagulation used.

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