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• W4387249518 abstract "SESSION TITLE: Cardiovascular Disease Case Report Posters 12 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Some of the major risk factors in ACS are thrombosis and bleeding. They become all the more significant in patients treated for STEMI associated with Out of Hospital cardiac Arrest (OHCA) wherein, after completion of immediate interventions aimed at restoring the normal blood flow, the later recuperation part involving antithrombotic therapies require a delicate balancing of these major risk factors, with can impact patient's short-term and long-term prognosis CASE PRESENTATION: A 70-year-old man was presented with OHCA. CPR was performed immediately, and urgent revascularization was done by PCI, as he was presented as STEMI. Due to cardiogenic shock, he was supported with mechanical circulatory support device (Impella), to improve hemodynamic stability. He was treated with antiplatelet and therapeutic anticoagulation therapies to control the risk of thrombosis post PCI and mechanical circulatory support.During hospitalization, he had several complications due to hemodynamic instability. Further investigations reported anemia and intra peritoneal bleed from concomitant liver and splenic lacerations which might have occurred during CPR. He was given multiple units of blood transfusions and operated several times to control the bleeding. Also the antiplatelet and anticoagulation therapies were adjusted to strike a balance between the risk of thrombosis without increasing the risk of bleeding. His clinical and hemodynamic parameters stabilized later, following which he was discharged to rehab. DISCUSSION: Therefore, the most appropriate strategy for the management of the acute ACS including STEMI is not only minimizing thrombosis leading to ischemic events but also to minimize the risk of bleeding. Such treatment plan encompasses various factors like selecting the most appropriate treatment plan taking into consideration the risk of the existing ACS, choosing the most appropriate dosage and duration and the type of antithrombotic therapies that can mitigate the bleeding risk and closely monitoring various other factors to control thrombosis and hemorrhage. In the present case, the patient has suffered severe complications due to hemodynamic instability even after successful completion of the procedure, due to severe bleeding from the concomitant liver and splenic lacerations during CPR leading to several rounds of blood transfusion and OR visits before he becomes hemodynamically stable and sent to rehab. These complications could have been minimized if the early signs of bleeding in the patient post resuscitation and PCI was immediately diagnosed. Further, focusing on vascular complications in the event of using pMCS devices is also important. CONCLUSIONS: Patients treated for STEMI associated with OHCA are at higher risk of thrombosis and bleeding than those who did not experience cardiac arrest. In this subset of patients, prospective studies are needed to better evaluate the balance of thrombosis and hemorrhage, and early detection of bleeding not only to reduce mortality but also to reduce length of hospital stay and cost. Currently randomized data on anticoagulation and bleeding reduction strategies are limited for different subset of people. There is need for more extensive clinical trials to establish relevant strategies suitable for different subset of people under varied circumstances like risk of existing disease, age, prevailing comorbidities. REFERENCE #1: 1. Emmanuel Gall, Alexandre Lafont, Olivier Varenne, Florence Dumas, Alain Cariou, Fabien Picard,Balancing thrombosis and bleeding after out-of-hospital cardiac arrest related to acute coronary syndrome: A literature review,Archives of Cardiovascular Diseases,Volume 114, Issue 10,2021,Pages 667-679,ISSN 1875-2136,https://doi.org/10.1016/j.acvd.2021.07.002 DISCLOSURES: No relevant relationships by Veera Pavan Kotaru No relevant relationships by Sai Rohit Mekala" @default.
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• W4387249518 date "2023-10-01" @default.
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• W4387249518 title "BALANCE BETWEEN THROMBOSIS AND MAJOR BLEEDING EVENTS IN A SPECIFIC SUBSET OF PATIENTS WITH OUT OF HOSPITAL CARDIAC ARREST (OHCA): A CASE REPORT" @default.
• W4387249518 doi "https://doi.org/10.1016/j.chest.2023.07.537" @default.
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