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Clinical and Experimental Medicine

, Volume 18, Issue 4, pp 481–485 | Cite as

Massive stent thrombosis during active ulcerative colitis: the tricky balance between manifest hemorrhagic and concealed thrombotic risk

  • Martino Pepe
  • Annagrazia Cecere
  • Pasquale D’Alessandro
  • Fabrizio Fumarola
  • Marco Matteo Ciccone
  • Alfredo Marchese
  • Andrea Igoren Guaricci
  • Arturo Giordano
  • Alessandro Santo Bortone
  • Stefano Favale
Letter to the Editor
  • 80 Downloads

Abstract

Inflammatory bowel diseases have been recognized as predisposing factors to atherosclerosis and thrombotic events, involving both the venous and the arterial circulatory systems. We report the case of a 70-year-old man who presented with ST elevation myocardial infarction during the active phase of ulcerative colitis (UC). Because of the ongoing hematochezia, after successful revascularization of the culprit vessel, the patient was medicated with Clopidogrel, in place of one of the more powerful new oral P2Y12 inhibitors that currently represent the gold standard therapy. Few days later a second elective percutaneous coronary intervention (PCI) on a non-culprit vessel ensued in a life-threatening early massive stent thrombosis involving the left main. During and after emergency PCI antiplatelet therapy was upgraded to Abciximab and Ticagrelor; this therapy proved successful in handling the massive stent thrombosis in the absence of severe bleeding complications. This case is unique and paradigmatic of the complex management of patients with coexisting active UC and acute coronary syndromes; it demonstrates as in this setting the balance between hemorrhagic and ischemic risk is labile and tricky to assess.

Keywords

Inflammatory bowel disease Inflammation Acute coronary syndrome Stent thrombosis Antiplatelet therapy Anticoagulation 

Notes

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest to disclose.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Martino Pepe
    • 1
  • Annagrazia Cecere
    • 1
  • Pasquale D’Alessandro
    • 1
  • Fabrizio Fumarola
    • 1
  • Marco Matteo Ciccone
    • 1
  • Alfredo Marchese
    • 2
  • Andrea Igoren Guaricci
    • 1
  • Arturo Giordano
    • 3
    • 4
  • Alessandro Santo Bortone
    • 5
  • Stefano Favale
    • 1
  1. 1.Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO)University of BariBariItaly
  2. 2.Department of Cardiology, Anthea HospitalGVM Care and ResearchBariItaly
  3. 3.Invasive Cardiology Unit“Pineta Grande” HospitalCastel VolturnoItaly
  4. 4.Department of Invasive CardiologyCasa di Salute “Santa Lucia”San Giuseppe VesuvianoItaly
  5. 5.Institute of Cardiac SurgeryUniversity of BariBariItaly

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