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Massive stent thrombosis during active ulcerative colitis: the tricky balance between manifest hemorrhagic and

Martino Pepe1, Annagrazia Cecere2, Pasquale D'Alessandro2

  • 1Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy. drmartinopepe@libero.it.

Clinical and Experimental Medicine
|August 24, 2018
PubMed

Insights

Patients with active ulcerative colitis (UC) face complex cardiovascular risks. This case highlights challenges in managing acute coronary syndromes and stent thrombosis in UC patients, balancing bleeding and clotting risks.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Pharmacology

Background:

  • Inflammatory bowel diseases (IBD), including ulcerative colitis (UC), are linked to increased risk of atherosclerosis and thrombotic events.
  • Managing patients with coexisting IBD and acute coronary syndromes (ACS) presents unique clinical challenges due to altered hemostatic balance.

Observation:

  • A 70-year-old man with active ulcerative colitis (UC) experienced ST-elevation myocardial infarction (STEMI).
  • Initial treatment with Clopidogrel post-PCI was complicated by massive early stent thrombosis during the active UC phase.
  • Subsequent emergency PCI with intensified antiplatelet therapy (Abciximab and Ticagrelor) successfully resolved the thrombosis without major bleeding.

Findings:

  • The case illustrates the delicate balance between hemorrhagic and ischemic risks in UC patients undergoing percutaneous coronary intervention (PCI).
  • Standard antiplatelet therapies may require careful consideration and potential modification in patients with active IBD and active bleeding.
  • Aggressive antiplatelet therapy, including glycoprotein IIb/IIIa inhibitors and potent P2Y12 inhibitors, can be effective in managing acute stent thrombosis even in high-risk IBD patients.

Implications:

  • This case underscores the need for individualized treatment strategies in patients with concurrent active UC and ACS.
  • Further research is warranted to establish optimal antiplatelet regimens for IBD patients, considering their prothrombotic state and bleeding risks.
  • Clinicians must carefully assess and manage the dual risks of thrombosis and bleeding when treating cardiovascular events in patients with active inflammatory bowel disease.

Keywords:
Acute coronary syndromeAnticoagulationAntiplatelet therapyInflammationInflammatory bowel diseaseStent thrombosis

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