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- W1975739633 abstract "Nous rapportons le cas d’un patient âgé de 70 ans, porteur de deux endoprothèses coronariennes pharmacoactives (ECPA) posées à moins de deux mois d’une gastrectomie totale, dans le cadre d’une néoplasie gastrique. Ce cas souligne les difficultés de prise en charge des patients ayant un risque thrombotique élevé à l’arrêt des antiagrégants plaquettaires (AAP) et un risque hémorragique élevé au maintien des AAP. À ce jour, il n’existe pas de recommandation de médecine factuelle sur lesquelles le praticien pourrait s’appuyer. Notre stratégie de prise en charge s’est basée sur des tests biologiques d’agrégabilité plaquettaire, non encore disponibles en pratique courante et non validés dans cette application, pour prédire le risque hémorragique. Actuellement, de nombreux tests biologiques sont à l’étude ; ceux-ci pourraient, après validation, permettre de guider la gestion périopératoire des AAP chez les patients chirurgicaux à haut risque thrombotique porteurs d’ECPA. We report the case of a 70-year-old patient, with two drug-eluting stents (DES), scheduled for a complete gastrectomy for a gastric cancer. This case underlines management problems regarding a patient with a high risk of DES thrombosis in case of AAP withdrawal and a high risk of bleeding in case of AAP maintenance. At this time, no evidence-based recommendation is available for clinicians to manage these patients. Our strategy was therefore based on platelet function monitoring test, which is however neither available in clinical practice nor validated to predict haemorrhagic risk. Several biologic tests are under study; they could be useful to guide perioperative management of antiplatelet therapy in the clinical setting of surgical patients with DES." @default.
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- W1975739633 date "2009-01-01" @default.
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- W1975739633 title "Stratégie de prise en charge d’un patient porteur d’endoprothèses coronaires pharmacoactives à haut risque thrombotique pour une gastrectomie totale" @default.
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- W1975739633 doi "https://doi.org/10.1016/j.annfar.2008.11.004" @default.
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