Access-site complications after rescue percutaneous coronary intervention during thrombolysis for acute myocardial infarction.
Aggressive antithrombotic medical therapy may increase the rate of access-site complications after percutaneous coronary intervention. Frequently, emergency coronary interventions have to be performed in a situation when thrombolysis therapy was administered as the first-line therapeutic approach in acute myocardial infarction but failed to achieve stable conditions. We analyzed the rate of femoral bleeding complications after emergency coronary intervention in 76 consecutive patients with unsuccessful thrombolysis in acute myocardial infarction. All invasive procedures were performed in a time period no longer than eight hours after thrombolysis was administered. Additional antithrombotic therapy with heparin and glycoprotein IIb/IIIa-inhibitors was given during intervention in 100% and 38.2% of patients, respectively. In three patients (3.9%) femoral hematomas without therapeutic consequences were documented; one patient (1.3%) developed a hematoma requiring blood transfusion. A pseudoaneurysm, fistula or surgical vascular intervention did not occur. Coronary interventional procedures in rescue situations can be performed with excellent safety with respect to access-site bleeding complications even under conditions of ongoing thrombolysis therapy and aggressive antithrombotic medical regimens.
Germing
A
A
Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. alfried.germing@ruhr-uni-bochum.de
Lindstaedt
M
M
Ulrich
S
S
Bojara
W
W
Lawo
T
T
Mügge
A
A
Grewe
P
P
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D004630:Emergencies; D005260:Female; D005263:Femoral Artery; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006406:Hematoma / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000009:adverse effects / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D019233:Retreatment; D012307:Risk Factors; D015912:Thrombolytic Therapy; D017211:Treatment Failure
D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin