title: Individualised dual antiplatelet therapy in a patient with short bowel syndrome after acute myocardial infarction with coronary artery stenting.
abstract: Short bowel syndrome after extensive surgical resection of the intestine is characterised by inadequate digestion and absorption of nutrients. Additional clinical problems include impaired absorption and metabolism of diverse drugs requiring individualised medical therapy or alternative treatments. We report a case of individualised dual antiplatelet therapy in a patient who underwent an extensive intestinal resection complicated by acute myocardial infarction requiring percutaneous coronary intervention and stent implantation. Genetic testing of CYP2C19 gene polymorphisms and platelet aggregation testing were used to assess responses to aspirin, clopidogrel, prasugrel and ticagrelor. Given its unique pharmacokinetics with good absorption and without need of metabolism to an active substance, ticagrelor appears to be the best for patients with short bowel syndrome who require dual antiplatelet therapy after coronary stent implantation.
authors.affiliation: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Droppa
authors.affiliation: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Karathanos
authors.affiliation: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.affiliation: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Geisler
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D056988:Anterior Wall Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D057285:Precision Medicine; D012778:Short Bowel Syndrome / Q000188:drug therapy / Q000209:etiology*; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine; D001241:Aspirin