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Cardiovascular Surgery News
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a:2:{s:4:"TEXT";s:137:"Experience of antiplatelet therapy after percutaneous coronary intervention in patients with ischemic heart disease and oncopathology ";s:4:"TYPE";s:4:"HTML";}


Authors: M.M. Dombrovskiy1, T.G. Nikitina1, N.N. Samsonova1, K.V. Petrosyan1, B.G. Alekyan2, L.A. Bockeria1

Company:
1Bakoulev National Medical Research Center of Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2 Vishnevskiy Institute of Surgery of Ministry of Health of the Russian Federation, str. Bolshaya Serpukhovskaya, 27, Moscow, 115478, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Heading: Original Research

UDC: 616.132:616.12-005.4-006-089.819.5:612.115.3

Link: Clinical Physiology of Blood Circulaiton. 2018; 2 (1): 10-15

Quote as: Dombrovskiy M.M., Nikitina T.G., Samsonova N.N., Petrosyan K.V., Alekyan B.G., Bockeria L.A. Experience of antiplatelet therapy after percutaneous coronary intervention in patients with ischemic heart disease and oncopathology. Novosti Serdechno-Sosudistoy Khirurgii (Cardiovascular Surgery News). 2018; 2 (1): 10–5 (in Russ.).

Received / Accepted:  19.02.2018/26.02.2018

Full text:  


Abstract

Оbjective. Аnalysis of the safety of use and the abolition of antiplatelet therapy in patients with ischemic heart disease and oncopathology.

Material and methods. From 2008 to 2017, 47 patients with ischemic heart disease and oncopathology were examined and treated in our center. Patients underwent percutaneous coronary intervention (PCI) in the first stage. Stents without drug coating were implanted in 27 (57.4%) patients, with drug coating – 20 (42.6%) patients. The choice of the type of stent was determined by the anatomy and the character of the lesion of the coronary arteries, as well as the timing of the alleged treatment of oncopathology. At discharge, continuous double antiplatelet therapy (DAPT) was recommended for at least 1 month with implantation of stents without drug coverage and 3 months for implantation of coated stents. Treatment of oncology was carried out on average 2.5±3 months after PCI, surgical treatment was performed 24 (51.1%) patients, chemotherapy / radiation therapy – 19 (40.4%) and combined treatment – 4 (8.5%). In surgical treatment of oncopathology, patients were recommended to stop DAPT and switch to heparin 5–7 days before the intervention of 26 (92.9%), and 2 (7.1%) – to perform treatment against acetylsalicylic acid. Return to double antiplatelet therapy (acetylsalicylic acid + clopidogrel) was recommended within the first 6–48 hours after the operation.

Results.
None of the patients showed significant intraoperative blood loss, as well as acute violations of coronary blood supply during the treatment of oncopathology. All fatal outcomes in 9 (19.1%) patients during 5 years of follow-up (mean follow-up period – 20.7±15) were due to the progression of oncology.

Conclusions. It is necessary to strictly adhere to two-component antiplatelet therapy within the recommended time frame with the resumption of DAPT in the first 6–48 hours after surgical treatment of oncopathology. If the terms of DAPT are observed after PCI, a subsequent temporary abolition of antiplatelet agents and the use of heparins as a “bridge” to surgical treatment of malignant tumors are possible.

References

  1. Chan A.O., Jim M.H., Lam K.F., Morris J.S., Siu D.C., Tong T. et al. Prevalence of colorectal neoplasm among patients with newly diagnosed coronary artery disease. JAMA. 2007; 298 (12): 1412–9.

  2. Yang S.Y., Kim Y.S., Chung S.J., Song JH., Choi S.Y., Park M.J. et al. Association between colorectal adenoma and coronary atherosclerosis detected by CT coronary angiography in Korean men; a cross-sectional study. J. Gastroenterol. Hepatol. 2010; 25 (11): 1795–9.

  3. Krone R.J. Managing coronary artery disease in the cancer patient. Prog. Cardiovasc. Dis. 2010; 53 (2): 149–56.

  4. Chen C.L., Parameswaran R. Managing the risks of cardiac therapy in cancer patients. Semin. Oncol. 2013; 40 (2): 210–7.

  5. Mistiaen W.P. Cancer in heart disease patients: what are the limitations in the treatment strategy? Future Cardiol. 2013; 9 (4): 535–47.

  6. Hawn M.T., Graham L.A., Richman J.S., Itani K.M., Henderson W.G., Maddox T.M. Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. JAMA. 2013; 310 (14): 1462–72.

  7. Kałuza G.L., Joseph J., Lee J.R., Raizner M.E., Raizner A.E. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J. Am. Coll. Cardiol. 2000; 35 (5): 1288–94.

  8. Kristensen S.D., Knuuti J., Saraste A., Anker S., B/otker H.E., De Hert S. et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur. Heart J. 2014; 35 (35): 2383–431.

  9. Fleisher L.A., Fleischmann K.E., Auerbach A.D., Barnason S.A., Beckman J.A., Bozkurt B. et al. 2014 АСС/АHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J. Am. Coll. Cardiol. 2014; 64 (22): e77–137.

  10. Fujikawa T., Tanaka A. Successful multidisciplinary treatment of hilar cholangiocarcinoma in a patient with complicated newonset coronary artery disease. BMJ Case Rep. 2014; 2014.

  11. Fukuyama K., Fujikawa T., Kuramitsu S., Tanaka A. Successful treatment of bleeding large duodenal gastrointestinal stromal tumour in a patient under dual antiplatelet therapy after recent drug-eluting coronary stent implantation. BMJ Case Rep. 2014.

  12. Savonitto S., D'Urbano M., Caracciolo M., Barlocco F., Mariani G., Nichelatti M. et al. Urgent surgery in patients with a recently implanted coronary drug-eluting stent: a phase II study of 'bridging' antiplatelet therapy with tirofiban during temporary withdrawal of clopidogrel. Br. J. Anaesth. 2010; 104 (3): 285–91.

  13. Rouine-Rapp K., McDermott M.W. Perioperative management of a neurosurgical patient with a meningioma and recent coronary artery stent. J. Clin. Anesth. 2013; 25 (3): 228–31.

  14. Warshauer J., Patel V.G., Christopoulos G., Kotsia A.P., Banerjee S., Brilakis E.S. Outcomes of preoperative bridging therapy for patients undergoing surgery after coronary stent implantation: a weighted meta-analysis of 280 patients from eight studies. Catheter Cardiovasc. Interv. 2015; 85 (1): 25–31.

  15. Ishikawa S., Kasai Y., Matsuura N., Tarumi S., Nakano J., Okuda M. et al. Perioperative management of lung cancer patients under antiplatelet or anticoagulant therapy. Kyobu Geka. 2015; 68 (4): 262–5.

  16. Maki M., Tsubochi H., Endo T., Endo S. Management of patients with ischemic heart disease in lung cancer resection. Kyobu Geka. 2015; 68 (4): 271–7.

  17. Kitamura Y., Suzuki K., Teramukai S., Sonobe M., Toyooka S., Nakagawa Y. et al. Feasibility of pulmonary resection for lung cancer in patients with coronary artery disease or atrial fibrillation. Ann. Thorac. Surg. 2017; 103 (2): 432–40.

  18. Collet J.P., Roffi M., Byrne R.A., Costa F., Valgimigli M. Casebased implementation of the 2017 ESC Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease: The Task Force for the Management of Dual Antiplatelet Therapy in Coronary Artery Disease of the European Society of Cardiology (ESC) and of the European Association for Cardio- Thoracic Surgery (EACTS). Eur. Heart J. 2018; 39 (3): e1–e33.

About Authors

  • Dombrovskiy Mikhail Mikhaylovich, Сand. Med. Sc., Junior Research Associate, Сardiologist;
  • Nikitina Tat'yana Georgievna, Dr. Med. Sc., Professor, Chief of Departmet, orcid.org/0000-0001-8175-1356;
  • Samsonova Natal'ya Nikolaevna, Dr. Med. Sc., Professor, Chief of Departmet, orcid.org/0000-0001-5711-6897;
  • Petrosyan Karen Valer'evich, Cand. Med. Sc., Chief of Department, orcid.org/0000-0002-3370-0295;
  • Alekyan Bagrat Gegamovich, Асademician of Russian Аcademy of Sciences, Deputy Director for Science and Technology Innovation, orcid.org/0000-0001-6509-566X;
  • Boсkeria Leo Antonovich, Асademician of Russian Аcademy of Sciences and Russian Academy of Medical Sciences, Director of Bakoulev National Medical Research Center of Cardiovascular Surgery, orcid.org/0000-0002-6180-2619

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