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Review
. 2021 Jan-Dec:9:23247096211005097.
doi: 10.1177/23247096211005097.

From Coronaries to Cirrhosis: The Role of Percutaneous Coronary Intervention and Dual Antiplatelet Therapy in End-Stage Liver Disease

Affiliations
Review

From Coronaries to Cirrhosis: The Role of Percutaneous Coronary Intervention and Dual Antiplatelet Therapy in End-Stage Liver Disease

Taylor C Remillard et al. J Investig Med High Impact Case Rep. 2021 Jan-Dec.

Abstract

Drug-eluting stents (DES) have superior efficacy compared with bare metal stents (BMS) for treatment of coronary artery lesions. However, BMS continue to play an important role in percutaneous coronary intervention for patients who are at a high bleeding risk, because they require a shorter duration of dual antiplatelet therapy. However, new developments in DES and understanding of the optimal time required for dual antiplatelet therapy after percutaneous coronary intervention may further limit the use of BMS. Furthermore, the use of dual antiplatelet therapy is complicated in patients with cirrhosis, who may have coagulopathy. In this article, we present the case of a patient with cirrhosis and end-stage chronic liver disease with coronary artery disease and a proximal left anterior descending stenosis who received a DES and had multiple episodes of gastrointestinal bleeding. We review the literature addressing DES and BMS in patients at high risk of bleeding. We also review the optimal duration of dual antiplatelet therapy.

Keywords: bleeding; coagulopathy; drug eluting; jaundice; stent; vascular ectasia.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Coronary artery lesions. In (A) AP/caudal and (B) RAO/caudal views of proximal left anterior descending artery (LAD) with subtotal occluded lesion >95% (white arrow in each), distal vessel filling with homo and heterocollaterals. Angiography of the left circumflex (LCx) revealed mild diffuse disease, and patent first obtuse marginal (OM1) branch. In (C) is shown a LAO/caudal view of after successful percutaneous coronary infection (PCI) of proximal LAD lesion (black arrow) with TIMI III flow 2 weeks after (A) and (B) were obtained.
Figure 2.
Figure 2.
Endoscopic bleeding lesions. On initial esophagoastroduodenoscopy 10 days after percutaneous coronary infection (PCI), vascular ectasias were identified in the duodenal bulb (A) and second portion of the duodenum (B). Yellow arrows point to ectasias. At the time of repeat esophagoastroduodenoscopy 2 weeks after initial endoscopy, evidence of mild portal hypertensive gastropathy was identified, along with a small non bleeding duodenal bulb vascular ectasia (center of the image; C) and a bleeding duodenal bulb vascular ectasia (D). The yellow arrow points to the edge of the bleeding lesion.

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