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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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Current Practice of Percutaneous Coronary Intervention in Patients With Coagulation Disorders
Michel El Khoury1, Boutros Karam2, Rabih Tabet2
1Internal Medicine, Staten Island University Hospital - Northwell Health, New York City, USA.
Cureus
|November 1, 2021
Summary
Patients with bleeding disorders face complex cardiovascular care. Managing acute coronary syndromes requires tailored antithrombotic and factor replacement therapies to balance bleeding and clotting risks.
Area of Science:
- Cardiology
- Hematology
- Interventional Cardiology
Background:
- Acute coronary artery disease (CAD) is a leading global cause of death.
- Coagulation disorders may offer protection against ischemic heart disease, but atherosclerotic lesions are observed in hemophilia patients.
- Increased life expectancy in patients with bleeding disorders leads to a higher incidence of cardiovascular diseases, complicating treatment.
Purpose of the Study:
- To review the challenges and strategies for managing acute coronary syndromes in patients with coagulation disorders.
- To highlight the need for individualized treatment approaches balancing antithrombotic and factor replacement therapies.
- To emphasize early screening and intervention for cardiovascular risk factors in this population.
Main Methods:
- Review of current literature and clinical practices for managing acute coronary syndromes (STEMI, NSTEMI, unstable angina) in patients with bleeding disorders.
- Discussion of interventional strategies, including stent selection and vascular access.
- Analysis of anticoagulation and antiplatelet therapy considerations, including prophylactic factor replacement.
Main Results:
- ST-elevation myocardial infarction (STEMI) requires prompt percutaneous coronary intervention (PCI), while non-STEMI (NSTEMI) and unstable angina necessitate hematology consultation.
- Newer drug-eluting stents may be safe with limited dual antiplatelet therapy (DAPT) duration (4 weeks) in high bleeding risk patients.
- Radial artery access is preferred over femoral access due to lower bleeding risk. Heparin is a preferred anticoagulant due to its short half-life and available antidote.
Conclusions:
- Managing acute coronary syndromes in patients with coagulation disorders requires careful, individualized antithrombotic and factor replacement strategies.
- Close peri-procedural monitoring and patient education on bleeding symptoms are crucial.
- Early screening for cardiovascular risk factors and timely intervention can improve outcomes and reduce morbidity in this population.
Keywords:
: acute coronary syndromebleeding riskcoagulation disorderscoronary artery angiogramprimary percutaneous interventionMore Related Videos
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