Warfarin treatment in stent thrombosis

AbstractA 62year-old male patient was admitted to the hospital due to anterior ST segment elevated myocardial infarction. Thrombotic complication developed three times during the hospitalization after primary percutaneous coronary intervention (PCI). Instent thrombus was identified despite the optimal medical therapy, new antiplatelet agents and intravascular ultrasound guided PCI. Therefore, symptoms were controlled with warfarin+clopidogrel treatment. At the third month of warfarin+clopidogrel treatment, the patient was asymptomatic and no active electrocardiographic changes were observed. Stent thrombosis developing under new antiplatelet agents constitutes a great problem and there are no clear data for the solution. We described an interesting case in which we achieved symptomatic control by warfarin+clopidogrel in the stent thrombosis developing during the treatment with dual antiplatelet therapy

Utility of Systematic Coronary Risk Evaluation (SCORE) system to predict coronary artery disease severity in low to moderate risk hypertensive patients undergoing elective coronary angiography

Background: Coronary artery disease (CAD) is the leading cause of mortality in hypertensive patients. Systematic Coronary Risk Evaluation (SCORE) is the preferred scoring system to predict future fatal cardiovascular events in hypertensive patients. However, the relationship between SCORE and coronary atherosclerosis is not well described. We aimed to investigate whether SCORE has a relationship with CAD severity in hypertensive patients, even in the absence of high risk features. Material and methods: Four hundred and fifty-two hypertensive patients who underwent elective coronary angiography and defined as low or moderate risk according to SCORE were included into the study. Patients were divided into two groups. Patients with a SCORE < 1% were defined as low risk group, and patients with a SCORE ≥ 1% and < 5% were defined as moderate risk group. The groups were compared regarding CAD severity. Results: The frequency of stenotic CAD and multivessel disease, and mean SYNTAX score, were significantly higher in SCORE ≥ 1%, and < 5% group compared to patients with SCORE < 1%. Correlation analysis revealed a significant positive moderate correlation between SCORE and SYNTAX score (Pearson’s r: 0.679, p < 0.001). ROC curve analysis demonstrated that a SCORE ≥ 3% predicted SYNTAX score > 22 with a sensitivity of 75% and a specificity of 86.5% (AUC: 0.879, p < 0.001). Furthermore, multivariate analysis demonstrated that SCORE was an independent predictor of stenotic CAD (OR: 1.616, p < 0.001), multivessel disease (OR: 1.913, p < 0.001), and SYNTAX score > 22. (OR: 1.817, p < 0.001). Conclusion: Our results suggest that SCORE is associated with CAD severity in hypertensive patients even in theabsence of high risk features. The SCORE system may be useful in further risk stratification of hypertensive patientswith moderate risk features and suspected CAD