RECURRENT THROMBOSIS OF THE STENT DUE TO HIGH-DOSE OMEPRAZOLE IN A PATIENT ON DUAL ANTIPLATELET THERAPY WITH CLOPIDOGREL: A CASE REPORT
Se presenta el caso de una mujer de 76 años quien consultó a
urgencias por angina de cuatro horas de evolución y un episodio de
hematemesis el cual se había presentado también la semana previa. Ingresó
con taquicardia, hipertensión y palidez mucocutánea. El electrocardiograma de
ingreso mostró descenso del ST en la pared lateral e inferior, la troponina inicial
fue negativa con un control positivo y el hemograma mostró anemia severa sin
compromiso de las demás líneas celulares. Se inició manejo con omeprazol en
infusión continua durante 72 horas y se transfundieron dos unidades de
glóbulos rojos. Posteriormente se realizó una endoscopia digestiva que mostró
una lesión de Dieulafoy sangrante que se trató con escleroterapia. Una semana
después fue llevada a angiografía coronaria con implante de un stent en la
arteria descendente anterior y se inició doble antiagregación con ácido acetil
salicílico y clopidogrel. Después del procedimiento tuvo nuevos episodios de
angina y requirió dos angiografías coronarias que demostraron trombosis
aguda y recurrente en el stent de la arteria intervenida, con intervenciones
fallidas, desarrollo de choque cardiogénico y finalmente la muerte.
RECURRENT THROMBOSIS OF THE STENT DUE TO HIGH-DOSE OMEPRAZOLE IN A PATIENT ON DUAL ANTIPLATELET THERAPY WITH CLOPIDOGREL: A CASE REPORT
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DOI: 10.22533/at.ed.1593462328063
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Palavras-chave: clopidogrel, omeprazole, stent, thrombosis, proton pump inhibitor, case report.
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Keywords: clopidogrel, omeprazole, stent, thrombosis, proton pump inhibitor, case report.
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Abstract:
The case of a 76-year-old woman who consulted the emergency room for angina of four hours of evolution and an episode of hematemesis which had also occurred the previous week is presented. She was admitted with tachycardia, hypertension, and mucocutaneous pallor. The electrocardiogram on admission showed ST depression in the lateral and inferior wall, the initial troponin was negative with a positive control, and the complete blood count showed severe anemia without involvement of the other cell lines. Management was started with omeprazole in continuous infusion for 72 hours and two units of red blood cells were transfused. Subsequently, a digestive endoscopy was performed, which showed a bleeding Dieulafoy lesion that was treated with sclerotherapy. One week later, she underwent coronary angiography with stent implantation in the left anterior descending artery, and dual antiplatelet therapy with aspirin and clopidogrel was started. After the procedure, she had new episodes of angina and required two coronary angiograms that demonstrated acute and recurrent thrombosis in the stent of the intervened artery, with failed interventions, development of cardiogenic shock, and finally death.
Clinical relevance: We present the case of a patient with concomitant use of high-dose intravenous omeprazole and clopidogrel. Possible interactions between these two drugs that may have contributed to the adverse outcomes in the patient are discussed.
- Christian David Messu Llano
- Verónica Maya Betancourt
- José Eduardo Citelli Ramírez
