title: [Percutaneous coronary intervention in a patient with  acute myeloid leukemia].
abstract: METHODS
  A 63-year-old woman was referred to our hospital for evaluation of leukocytopenia and blast cells in the peripheral blood smear. The general condition was reduced, a maculo-papulous exanthema of the face and upper body as well as a general lymphadenopathy were found.
  
  
  METHODS
  Bone marrow examination revealed the diagnosis of acute myeloid leukemia (AML) FAB M1 and a normal karyotype. Extramedullary manifestations of AML were demonstrated in skin and lymphnode biopsies. ECG showed no signs of ischemia, echocardiography a normal left-ventricular function.
  
  
  METHODS
  The patient received induction treatment using sequential high-dose cytosinarabinosid and mitoxantrone, which rapidly resolved the extramedullary skin- and lymphnode-manifestations of the AML. During the chemotherapy-associated bone marrow aplasia a non-ST-elevation infarction (NSTEMI) developed combined with severe ischemic cardiomyopathy, high-grade mitral valve deficiency and serious congestive heart failure with respiratory failure. Coronary artery angiography showed a complete occlusion of the proximal ramus circumflexus. Percutanous coronary intervention (PCI) with implantation of a bare-metal stent was performed, which resulted in prompt improvement of the condition. Despite the transfusion-dependent thrombocytopenia a dual antiplatelet therapy with acetylsalicylic acid and clopidogrel was given. After each unit of platelets transfused a loading dose of 600 mg clopidogrel was given to prevent stent thrombosis. The patient did not experience major bleeding and was discharged in complete remission of AML and completely cardially recompensated.
  
  
  CONCLUSIONS
  Coronary angiography and stenting can generally be safely performed in patients with transfusion-dependent thrombocytopenia. Despite a higher risk of bleeding an oral dual antiplatelet therapy with aspirin and e. g. clopidogrel according to the guidelines should be performed, but its duration should be adapted to the individual patient circumstances.
authors.affiliation: Klinik für Hämatologie und Onkologie, St.-Antonius-Hospital, Eschweiler. peter.staib@sah-eschweiler.de
authors.forename: P
authors.initials: P
authors.lastname: Staib
authors.forename: S
authors.initials: S
authors.lastname: Forsch
authors.forename: A
authors.initials: A
authors.lastname: Niedeggen
authors.forename: U
authors.initials: U
authors.lastname: Janssens
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D017023:Coronary Angiography; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000139:chemically induced / Q000628:therapy; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000628:therapy*; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D017713:Platelet Transfusion; D012074:Remission Induction; D015607:Stents; D013921:Thrombocytopenia / Q000139:chemically induced / Q000628:therapy
chemical_list: D010975:Platelet Aggregation Inhibitors; D003561:Cytarabine; D008942:Mitoxantrone