title: In-stent thrombosis following DDAVP administration: case report and review of the literature.
abstract: A 67-year-old man with a drug-eluting stent in his proximal left anterior descending artery was admitted to the hospital after sustaining a traumatic injury to the skull. Due to persistent bleeding from a subgaleal hematoma, intravenous 1-desamino-8-D-arginine vasopressin (DDAVP) was administered. Five hours later, the patient complained of crushing chest pain. A 12-lead electrocardiogram demonstrated 2 mm ST-segment elevations in the precordial leads with reciprocal depressions in the inferior leads. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending stent with TIMI 0 flow. Another drug-eluting stent was placed inside the original stent with restoration of TIMI 3 flow. During the catheterization, the patient became progressively hypoxic and hypotensive requiring intubation, dopamine drip, and placement of an intra-aortic balloon pump. The patient's hospitalization was complicated by prolonged shock requiring inotropes and vasopressors. This is the first reported case of an ST-elevation myocardial infarction due to in-stent thrombosis occurring after DDAVP administration. Though DDAVP is well tolerated and efficacious in treating several types of coagulopathies, this case illustrates its potential pro-thrombotic effects. Therefore, DDAVP should be used with caution in patients with known coronary artery disease and coronary stents.
authors.affiliation: aLeon H. Charney Divison of Cardiology, Department of Medicine, New York University Langone School of Medicine bDepartment of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Sunny N
authors.initials: SN
authors.lastname: Shah
authors.forename: Henry A
authors.initials: HA
authors.lastname: Tran
authors.forename: Amer
authors.initials: A
authors.lastname: Assal
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Ascunce
authors.forename: Leonid
authors.initials: L
authors.lastname: Yatskar
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
mesh_terms: D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage* / Q000009:adverse effects*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D012886:Skull / Q000293:injuries; D013927:Thrombosis / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery
chemical_list: D001127:Arginine Vasopressin