title: Coronary stent thrombosis in patients undergoing multidigit replantation.
abstract: OBJECTIVE
  The development of drug-eluting stents has decreased the rate of in-stent restenosis. However, there have been reports of late stent thrombosis in patients with drug-eluting stents, especially when dual antiplatelet therapy is interrupted. The high mortality rate associated with cardiac stent thrombosis has led to recent recommendations regarding duration of antiplatelet therapy as well as timing of elective surgery in patients with both drug-eluting stents and bare metal stents. However, in patients requiring emergency operations, delaying surgery is not an option.
  
  
  METHODS
  In a retrospective review of 65 patients undergoing replantation from 2005 to 2010, only two patients with coronary stents presented, both with drug-eluting stents. Both of these patients developed acute in-stent thrombosis postoperatively (days 5 and 2) despite continuing dual antiplatelet therapy while undergoing multidigit replantation.
  
  
  CONCLUSIONS
  Several factors including large transfusion requirements and the complex pharmacogenetics of clopidogrel may have played a role. These cases bring to light the increasing number of patients with indwelling drug-eluting stents in whom the need for massive surgical or trauma type management will become more frequent.
authors.affiliation: Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA. jacobj15@nyumc.org
authors.forename: Jordan
authors.initials: J
authors.lastname: Jacobs
authors.forename: Alan
authors.initials: A
authors.lastname: Shah
authors.forename: Andrew
authors.initials: A
authors.lastname: Zinn
authors.forename: Jamie
authors.initials: J
authors.lastname: Levine
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D003328:Coronary Thrombosis / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011183:Postoperative Complications / Q000139:chemically induced; D012092:Replantation / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors