Dilatative percutaneous tracheostomy during double antiplatelet therapy: two consecutive cases

Area of Science:

• Cardiology
• Critical Care Medicine
• Surgical Procedures

Background:

• Double antiplatelet therapy is crucial after coronary stent placement to prevent stent thrombosis.
• Percutaneous tracheostomy is an essential procedure for patients requiring prolonged mechanical ventilation.
• The safety of percutaneous tracheostomy in patients on double antiplatelet therapy is not well-established due to bleeding risks.

Observation:

• Two cases of dilatative percutaneous tracheostomy were performed on patients with cardiac arrest post-myocardial infarction, who were on double antiplatelet therapy.
• The double antiplatelet therapy was continued during the tracheostomy procedure due to high risk of stent thrombosis.
• Patients were selected based on the absence of other significant risk factors for bleeding.

Findings:

• No immediate or late hemorrhagic complications were observed in either patient following the procedure.
• Dilatative percutaneous tracheostomy was successfully performed without compromising the antiplatelet regimen.
• The study suggests that this procedure can be safely conducted in carefully selected patients.

Implications:

• This case report suggests a potential safe approach for performing dilatative percutaneous tracheostomy in critically ill patients requiring dual antiplatelet therapy.
• It may help guide clinical decision-making in managing airway and cardiovascular risks concurrently.
• Further studies are warranted to confirm the safety and efficacy in a larger patient cohort.