Apixaban for massive intracoronary thrombosis: A case series

Özet

The common pathophysiology of acute coronary syndrome is usually thrombus formation after rupture or erosion of the coronary artery plaque. The key goal of treatment is to resolve ischemia by early revascularization and prevent complications, such as death, re-infarction, or life-threatening arrhythmias (1). Coronary thrombus burden is a significant factor affecting the success of percutaneous coronary intervention (PCI) during revascularization. Failure of recanalization, distal embolization, no reflow and impaired myocardial perfusion and function, stent malapposition, and stent thrombosis are frequently encountered complications during PCI of patients with massive thrombus (2-4). Thrombus burden can be reduced by pharmacological or mechanical methods, as a bail-out choice, to increase the success of the procedure. The recommended pharmacological treatment options are intravenous or intracoronary fibrinolytic agents or antiplatelet agents, such as glycoprotein GP IIb/IIIa inhibitors, in addition to the standard antiplatelet procedure. In this case series, we presented two patients with acute coronary syndrome and severe thrombus burden in the ectatic coronary arteries, resolved by apixaban treatment as a novel approach, in addition to the dual antiplatelet therapy.