Acute myocardial infarction in a patient with active actinic rectitis bleeding: Between the sword and the wall

Area of Science:

• Cardiology
• Vascular Surgery
• Oncology

Background:

• Coronary artery bypass graft (CABG) is a common surgical procedure.
• Managing patients with concurrent cardiovascular disease and active bleeding presents significant clinical challenges.
• Actinic rectitis following prostate cancer radiation therapy can cause severe gastrointestinal bleeding.

Observation:

• A 79-year-old male presented with unstable angina and active lower gastrointestinal bleeding.
• The patient had undergone radiation therapy for prostate carcinoma one year prior, resulting in actinic rectitis.
• Coronary angiography revealed significant stenosis in the left anterior descending artery.

Findings:

• Standard antiplatelet or heparin therapies for coronary artery disease were contraindicated due to active rectal bleeding.
• Off-pump CABG was successfully performed without the use of systemic heparin.
• The patient experienced a favorable recovery following the procedure.

Implications:

• CABG without systemic heparin is a viable and safe option for carefully selected patients with active bleeding complications.
• This case highlights the importance of tailored surgical strategies in complex cardiovascular cases.
• Further research may explore the expanded indications and safety profiles of heparin-free CABG in bleeding patients.