The Use of Cangrelor as Bridge Antiplatelet Therapy in a Patient with Recent Percutaneous Coronary Intervention for Acute Coronary Syndrome, Who Developed Esophageal Perforation After Transesophageal Echocardiography.

Ulviyya Guliyeva, Kurtuluş Karaüzüm, İsa Çam, Revan İsrafilov, Ahmet Faruk Koç, Didar Mirzamidinov, Hasan Yılmaz, İrem Karaüzüm, Tayfun Şahin, Ertan Ural
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Abstract

Dual antiplatelet therapy (DAPT) is a vital part of the pharmacological management in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). While early discontinuation of DAPT increases ischemic risk, some patients on DAPT may require urgent surgery, necessitating its interruption. Cangrelor, an intravenous P2Y12 antagonist, provides strong platelet inhibition within minutes and platelet activity normalizes within one hour after the cessation of the drug. Bridging antiplatelet therapy with cangrelor has been increasingly studied as an alternative option to ensure the continuation of platelet inhibition in CAD patients who require discontinuation of DAPT. The present patient, with a recent history of PCI for acute coronary syndrome, experienced a significant esophageal perforation following transesophageal echocardiography (TEE). This severe complication was effectively managed endoscopically, and as part of the recent PCI treatment, prolonged cangrelor infusion was successfully utilized with no thrombotic or bleeding events throughout the management of the complication.

近期因急性冠状动脉综合征接受经皮冠状动脉介入治疗的患者在接受经食道超声心动图检查后出现食道穿孔,如何使用坎格雷洛作为桥接抗血小板疗法?
双联抗血小板疗法(DAPT)是接受经皮冠状动脉介入治疗(PCI)的冠状动脉疾病(CAD)患者药物治疗的重要组成部分。虽然过早停用 DAPT 会增加缺血风险,但一些接受 DAPT 治疗的患者可能需要紧急手术,因此有必要中断 DAPT。静脉注射 P2Y12 拮抗剂 Cangrelor 可在数分钟内强效抑制血小板,停药后一小时内血小板活性恢复正常。对于需要停用 DAPT 的 CAD 患者,研究越来越多地将坎格雷乐作为一种替代抗血小板疗法,以确保血小板抑制作用的持续性。本例患者近期曾因急性冠状动脉综合征接受过 PCI 治疗,在接受经食道超声心动图 (TEE) 检查后出现了严重的食道穿孔。这一严重并发症在内镜下得到了有效控制,作为近期 PCI 治疗的一部分,在控制并发症的整个过程中成功使用了长效坎格雷洛输注,没有发生血栓或出血事件。
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