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Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2010;5(3):227-230.
Published online July 31, 2010.
A stent thrombosis that developed due to altered preoperative anticoagulation therapy in a patient with a drug eluting stent (DES): A case report
Jong Taek Park, Kwan Hoon Choi, Jang Young Kim, Il Hwan Park, Sungwoo Ryoo, Hyun Kyo Lim
1Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
2Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
3Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
4Department of Biological Sciences, College of Natural Sciences, Kangwon University, Chuncheon, Korea.
A 73 year-old man was admitted to our hospital because of septic shock. He had undergone drug eluting stent (DES) insertion 40 days before this admission. After about 50 days in the hospital, a coccyx sore required a flap operation. The anticoagulation therapy (aspirin and clopidogrel) was then changed to LMWH. Eleven days after this change, he developed very severe chest pain. The emergency coronary angiography showed occlusion of the left anterior descending artery, left circumflex artery, and right coronary artery due to thrombosis. During the angiography procedure, his heart collapsed. We performed cardio-pulmonary resuscitation (CPR), but were unsuccessful. Patients in very high risk groups need special attention during peri-operative periods. Doctors must have full knowledge about the different anticoagulation strategies, and cooperation among the different clinical departments is needed to properly treat these high risk patients.
Key Words: Percutaneous coronary intervention, Preoperative anti-coagulation therapy, Stent thrombosis

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