DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201544

Systemic thrombolysis with tenecteplase in stent thrombosis patients as a life saving measure in odd situations: an observational study from tertiary care hospital

Awadhesh Kumar Sharma, Neeraj Prakash, M. M. Razi, Sameer Sarraf, Santosh Sinha, Umeshwar Pandey, Ramesh Thakur

Abstract


Background: Coronary artery stent thrombosis specifically acute stent thrombosis is always a nightmare for interventionist. Stent thrombosis is one of a severe and catastrophic complication of percutaneous coronary intervention (PCI). Repeat PCI is commonly considered the preferred strategy to manage patients with stent thrombosis. Thrombolytic therapy is considered only partially effective.

Methods: This was a single centre largest ever observational study on this topic comprising of total 110 patients with history of previous stent implantation and now presented with an acute ST segment elevation myocardial infarction due to a probable stent thrombosis successfully treated with systemic thrombolysis with tenecteplase were studied over the period of 2 years (April 2017 to March 2019).

Results: On analyzing data clinical success was reported in 92 (83.6%) patients, electrocardiographic success is seen in 102 (92.7%) patients while angiographic success was reported in 80(72.7%) patients. Cerebrovascular accident were reported in 2 (1.8%) patients which died later on.

Conclusions: This study which is the first ever largest observational study on this topic demonstrates that, in patients with probable stent thrombosis and a short time to reperfusion in some specific extraordinary situations where timely percutaneous coronary intervention is not possible, systemic thrombolysis by fibrin specific Tenecteplase can be done as a life saving procedure which is associated with good immediate results.


Keywords


Catheterization lab, Coronary angiography, Stent thrombosis, Systemic thrombolysis, ST segment elevation myocardial infarction, Tenecteplase

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References


Burzotta F, Romagnoli E, Manzoli A, Pristipino C, Belloni F, Sardella G, et al. The outcome of PCI for stent-thrombosis multicentre study (OPTIMIST): Rationale and design of a multicentre registry. Am Heart J. 2007;153:377(3);e1-7.

Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, at el. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293(17):2126-30.

Tyczyński P, Karcz MA, Kalińczuk Ł, Fronczak A, Witkowski A. Early stent thrombosis. Aetiology, treatment, and prognosis. Postepy Kardiol Interwencyjnej. 2014;10(4):221-5.

Luscher TF, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, at el. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation. 2007;115(8):1051-8.

Gurbel PA, Bliden KP, Guyer K, Cho PW, Zaman KA, Kreutz RP, at el. Platelet reactivity in patients and recurrent events post-stenting: results of the PREPARE POST-STENTING Study. J Am Coll Cardiol. 2005;46(10):1820-6.

Holmes DR, Kereiakes DJ, Laskey WK, Colombo A, Ellis SG, Henry TD, et al. Thrombosis and drug-eluting stents. J Am Coll Cardiol. 2007 Jul 10;50(2):109-18.

Sciahbasi A, Patrizi R, Madonna M, Summaria F, Scioli R, Carlino G, et al, MD Can J Cardiol. 2009 Jun; 25(6): e213-4.

Bowater SE, Doshi SN, Buller NP. Subacute stent thrombosis successfully treated with thrombolysis and glycoprotein IIb/IIIa inhibition. Heart. 2005;91(4):488.

Gurwitz JH, Gore JM, Goldberg RJ, Barron HV, Breen T, Rundle AC, et al. Risk for intracranial hemorrhage after tissue plasminogen activator treatment for acute myocardial infarction. Participants in the National Registry of Myocardial Infarction 2. Ann Intern Med. 1998 Oct 15;129(8):597-604.

The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction Original Research Article. Lancet 2001 Aug 25;358(9282):605-13.

Assessment of the safety and efficacy of a New Thrombolytic Investigators Single bolus tenecteplase compared with front loaded alteplase in acute myocardial infarction: the ASSENT- 2 double blind randomized trial. Lancet 1999 Aug 28;354(9180):716-22.

Bonnefoy E, Lapostolle F, Leizorovicz A, Steg G, McFadden EP, Dubien PY, et al. Comparison of Angioplasty and Prehospital Thrombolysis in Acute Myocardial Infarction Study Group. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002 Sep 14;360(9336):825-9.

Mamtimin H, Rupprecht HJ, Nowak B, Voigtlander T, Darius H, Meyer J. Comparison of reoPro (abciximab) versus intracoronary thrombolysis for early coronary stent thrombosis. Int J Cardiovasc Intervent. 2000;3(3):173-9.

Kunadian V, Gibson CM. Thrombolytics and myocardial infarction. Cardiovascular therapeutics. 2012 Apr;30(2):e81-8.