Patient with Severe Gum and Nose Bleeding, Inferior Wall MI with Severe Thrombocytopenia

By
A.M. Thirugnanam
Operator(s)
AM Thirugnanam, MD, MSICP, PhD, FSCAI; Senior Interventional Cardiologist; Ipcard Cardiac Care Center, Hyderabad, Andhra Pradesh, India
Affiliation
Ipcard Cardiac Care Center, Hyderabad, India
Facility / Institute
Kamineni Hospitals, Hyderabad, India
Clinical History
60 yrs old male, had no significant medical and surgical history. One evening the patient shifted from one hospital to our tertiary care center with the complaints of severe chest pain, gums and nose bleeding after thrombolysis with STK in STEMI of IWMI. His BP-60/80mmhg, HR-120, LVEF-50%, ECG- ST elevation in inferior leads. saturation-96% at room air, RBS-115 mg/dl, Creatinine-1.2, urea-25 mg/dl, cTnI-15 ng/dl, other cardiac enzymes all elevated more than 3 times. TLC-11500, Platelets-35.000, ACT-1200 sec.
Angiography
Coronary was done under right radial artery LM- normal LAD- type III, and normal Diagonals are normal, (Figure 1) RCA-proximal 95% occlusion (Figure 2)
Procedure
No loading dose of clopidogrel and aspirin, no heparin and other anti coagulation. Pre cath cock tail without heparin.Patient was given bolus IV fluids and maintenance IV fluids. RCA ostium was engaged with 6FR JR-3.5 guide catheter. Proximal RCA lesion was crossed with out any difficulty with BMW guide wire 0.014 and kept in distal RCA. 3*15mm multi link cobalt chromium, (Abbott) stent was deployed directly without predilatation (Figure 3). Second time inflation was done with the same stent balloon with 15 atm pressure (Figure 4). Final results revealed TIMI-III flow and no residual thrombus found. No anti thrombin and anti coagulation were given during and after procedure.
Conclusion(s) / Result(s)
Final results was excellent, no residual thrombus or procedure related complications were seen. patient was discharged on third day with statin, nicorandil, and low dose ARB.
Comments/Lessons
In idiopathic thrombocytopenia with myocardial infarction, initial management and decision making are important part of treatment. Medical management is literally out of choice. No anti-thrombotic and anti-coagulation, i.e dry vessel angioplasty with radial approach will reduce complications and gives promising results. Restricted hard ware usage is very important, particularly, thrombus aspiration, rotablator.
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Conflicts of Interest
None

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