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Management of patients with coronary stents in the ICU

Brilakis, Emmanouil S; Banerjee, Subhash

Current Opinion in Critical Care:
doi: 10.1097/MCC.0b013e32833e1075
Cardiovascular system: Edited by Gerasimos Filippatos
Abstract

Purpose of review: To review the contemporary management of patients with coronary stents in the ICU.

Recent findings: Coronary stent patients admitted in the ICU may be at increased risk for stent thrombosis, a catastrophic complication with high morbidity and mortality. Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist significantly reduces the risk of stent thrombosis; however, it may occasionally need to be discontinued in case of bleeding or when high bleeding risk invasive procedures need to be performed. In such cases, if aspirin can be continued, it can provide some protection from complications. If all antiplatelet therapy needs to be discontinued, temporary administration of a short-acting antiplatelet agent, such as a small molecule glycoprotein IIb/IIIa inhibitor may be helpful. Close monitoring of coronary stent patients may allow prompt diagnosis and treatment of any cardiac complications in the ICU.

Summary: Awareness of the potential risks of coronary stent patients coupled with close monitoring and meticulous attention to the optimum antiplatelet therapy can optimize the outcomes of coronary patients admitted in the ICU.

Author Information

VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA

Correspondence to Emmanouil S. Brilakis, MD, PhD, Division of Cardiology (111A), VA North Texas Healthcare System, The University of Texas Southwestern Medical Center at Dallas, 4500 S. Lancaster Rd, Dallas, TX 75216, USA Tel: +1 214 857 1547; fax: +1 214 302 1341; e-mail: esbrilakis@yahoo.com

© 2010 Lippincott Williams & Wilkins, Inc.