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Urgent Revascularization of the Left Proximal Circumflex Following Cessation of Cangrelor Within Six Hours of
Sherri Huang1, Camilo Rodriguez2, Khalid Shakfeh2
1Internal Medicine and Pediatrics, University of South Florida Morsani College of Medicine, Tampa, USA.
Insights
Bridging anticoagulation protocols may pose risks for patients with a history of clotting. Customized discontinuation timing for bridging agents is crucial to prevent thrombotic events, especially after procedures.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Medicine
Background:
- Patients undergoing procedures often require temporary cessation of anticoagulants.
- Bridging therapy with short half-life anti-platelet agents is a common practice.
- Standard protocols guide the transition from anticoagulants to bridging agents.
Observation:
- A patient with a history of in-stent thromboses experienced a thrombotic event.
- This event occurred despite adherence to a literature-guided bridging protocol.
- The patient required urgent revascularization after stopping cangrelor within six hours.
Findings:
- Stopping cangrelor prematurely (within six hours) can precipitate thrombotic events.
- Existing bridging protocols may not adequately address patients with a history of hypercoagulability.
- This case highlights a potential failure point in standard bridging strategies.
Implications:
- Bridging agent discontinuation timing should be individualized based on patient-specific risk factors, particularly a history of thrombosis.
- Further research is needed to refine bridging protocols for high-risk cardiovascular patients.
- Personalized medicine approaches are essential for optimizing peri-procedural anticoagulation management.
Abstract:
Patients undergoing procedures are often transitioned off anticoagulants using anti-platelet agents with short half-lives as a "bridge." We present the case of a patient with a history of in-stent thromboses who experienced a thrombotic event following a literature-guided bridging protocol. This case is one of the first to show that stopping cangrelor within six hours led to a need for urgent revascularization and suggests that the timing for discontinuing bridging agents should be customized based on the patient's history of increased blood clotting.
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