Anti-aggregants and anticoagulants in the management of coronary ectasia with slow flow, a review of case report
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Published:
Nov 16, 2020
Keywords:
Coronary aneurysm, myocardial infraction, coronary angiography, antiplatelets agents, anticoagulants agents
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Abstract
Coronary ectasia is a profuse dilation of the entire arterial segment. The most appropriate therapy for the thrombogenic process that accompanies coronary ectasia has not yet been determined, so the objective of this study is to establish whether the therapies: double antithrombotic (SAPT + OAC), triple (DAPT + OAC) or alone with oral anticoagulant (OAC) are helpful in preventing recurrence of symptoms. A search was carried out for case reports on coronary ectasia and management with anticoagulants and/or antiaggregant for the prevention of relapses, published from 1997 to May 2020. Eleven reports were included. Five patients received triple antithrombotic therapy (DAPT + OAC), three patients received double antithrombotic therapy (SAPT + OAC), and three patients received oral anticoagulant therapy (OAC) alone. None had recurrences in the follow-up period. Both therapy with only OAC, as well as double antithrombotic therapy (OAC + SAPT) and triple (OAC + DAPT) showed benefit in preventing recurrences of acute coronary syndrome (ACS) after follow-up of at least 3 months. Triple antithrombotic therapy appears to be more effective than the use of DAPT alone. The use of novel oral anticoagulants (NOAC) could have a greater benefit over the use of traditional ones. However, more studies are required in this regard.
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Barreno Arcos A, Bustamante NC. Anti-aggregants and anticoagulants in the management of coronary ectasia with slow flow, a review of case report. REMCB [Internet]. 2020Nov.16 [cited 2024Jul.3];41(2):149-58. Available from: https://remcb-puce.edu.ec/remcb/article/view/868
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References
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Pinar Bermúdez E, López Palop R, Lozano Martínez-Luengas I, Cortés Sánchez R, Carrillo Sáez P, Rodríguez Carreras R, Picó Aracil F, Valdés Chávarri M. 2003. Ectasia coronaria: prevalencia, características clínicas y angiográficas. Revista Española de Cardiología 56:473-479.
Pranata R, Yonas E, Chintya V, Alkatiri A. 2019. Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports. International Journal of Angiology 28:231-236.
Robinson F. 1985. Aneurysms of the coronary arteries. American Heart Journal 109:129-135. Sarkar A, Grigg W, Lee J. 2020. TIMI Grade Flow. StatPearls Publishing.
Swanton R, Thomas M, Coltart D, Jenkins B, Webb-Peploe M, Williams B. 1978. Coronary artery ectasia--a variant of occlusive coronary arteriosclerosis. Heart 40:393-400.
Waqas M, Bizzocchi L, Menegus M, Faillace R. 2019. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus 11:e3928.
Yan Q, Ning L, Jian Y, Yang W, Yuan Q, Du Z. 2020. Could the Novel Oral Anticoagulants Be Used for Coronary Artery Aneurysm?. Case Reports in Medicine 2020:1-4.
Akyürek Ö, Berkalp B, Sayın T, Kumbasar D, Kervancıoğlu C, Oral D. 2003. Altered coronary flow properties in diffuse coronary artery ectasia. American Heart Journal 145:66-72.
Ali D, Asghar D, Yasir D. 2017. Coronary artery ectasia; prevalence and clinical characteristics: experience from a single cardiac center. The professional medical journal 24:545-553.
Alkhouli M, Nunez Gil I. 2019. Coronary Ectasia. Expert Analysis. American College of Cardiology. Awamleh P, Casado R, Mata R. 2017. Ectasia coronaria y lesiones trombóticas como causa de síndrome coronario agudo. Revista Colombiana de Cardiología 24:131.e1-131.e4. [accessed 2020 Jun 15].
Chia H, Tan K, Jackson G. 1997. Aneurismas de la arteria coronaria no aterosclerótica: dos informes de casos. Corazón 78:613-616. [accessed 2020 Jun 15].
Chongprasertpon N, Coughlan J, Ibrahim M, Kiernan T. 2018. Spontaneous thrombosis in an ectatic right coronary artery. BMJ Case Reports. Damay V, Pranata R, Wiharja W. 2019. Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report. Journal of Medical Case Reports 13.
Devabhaktuni S, Mercedes A, Diep J, Ahsan C. 2016. Coronary Artery Ectasia-A Review of Current Literature. Current Cardiology Reviews 12:318-323.
Doi T, Kataoka Y, Noguchi T, Shibata T, Nakashima T, Kawakami S, Nakao K, Fujino M, Nagai T, Kanaya T et al. 2017. Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction. Highlights. Arteriosclerosis, Thrombosis, and Vascular Biology 37:2350-2355.
Dwyer J, Flesch-Janys D. 1995. Agent Orange in Vietnam. American Journal of Public Health 85:476-478.
Eikelboom J, Connolly S, Bosch J, Dagenais G, Hart R, Shestakovska O, Diaz R, Alings M, Lonn E, Anand S et al. 2017. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. New England Journal of Medicine 377:1319-1330.
Erden İ, Erden E, Özhan H, Karabulut A, Ordu S, Yazici M. 2010. Outcome of Primary Percutaneous Intervention in Patients With Infarct-Related Coronary Artery Ectasia. Angiology 61:574-579.
Genena K, Ali M, Christmas D, Siu H. 2018. Coronary Artery Ectasia Presenting as a Non-ST Elevation Myocardial Infarction in a Young Adult: Case Presentation and Literature Review. Case Reports in Cardiology 2018:1-3.
Gunasekaran P, Drees T, Fritzlen J, Haghnegahdar M, Earnest M, Mehta A, Hockstad E, Wiley M, Tadros P, Dawn B et al. 2018. Dual antiplatelet therapy or oral anticoagulation reduces the incidence of acute coronary syndromes in patients with coronary artery ectasia. Journal of the American College of Cardiology 71:A1406.
Hammer G, McPhee S. 2019. Fisiopatología de la enfermedad. 2nd ed. México, D.F.: Mc Graw Hill. Kammoun Y, Bahloul A, Ellouz T, Saray H, Dammak M, Abid L, Hentati M, Kammoun S. 2019. Thrombotic Coronary Ectasia and the Interest of Oral Anticoagulation: Case Report. Clin Med Case Rep 3:125.
Kawsara A, Núñez Gil I, Alqahtani F, Moreland J, Rihal C, Alkhouli M. 2018. Management of Coronary Artery Aneurysms. JACC: Cardiovascular Interventions.
Lee H, Lin T, Su H, Voon W, Lai W, Sheu S, Hsu P. 2013. Recurrent Thrombosis in a Case of Coronary Ectasia with Large Thrombus Burden Successfully Treated by Adjunctive Warfarin Therapy. Acta Cardiol Sin 29:462-466.
Li Y, Wu C, Liu W. 2017. Coronary artery ectasia presenting with thrombus embolization and acute myocardial infarction. Medicine 96:e5976.
Lima B, Varma S, Lowe J. 2006. Nonsurgical Management of Left Main Coronary Artery Aneurysms: Report of 2 Cases and Review of the Literature. Tex Heart Inst J 33:376-379.
Luo Y, Tang J, Liu X, Qiu J, Ye Z, Lai Y, Yao Y, Li J, Wang X, Liu X. 2016. Coronary Artery Aneurysm Differs From Coronary Artery Ectasia: Angiographic Characteristics and Cardiovascular Risk Factor Analysis in Patients Referred for Coronary Angiography. Angiology 68:823-830.
Malviya A, Jha P, Mishra A. 2017. Isolated coronary artery ectasia: Clinical, angiographic, and follow up characteristics. Indian Heart Journal 69:619-623.
Manginas A, Cokkinos D. 2006. Coronary artery ectasias: imaging, functional assessment and clinical implications. European Heart Journal 27:1026-1031.
Matthew S, Timothy E P. 2018. Coronary Artery Ectasia: An Interventional Cardiologist's Dilemma. International Archives of Cardiovascular Diseases 2.
Papadakis M, Manginas A, Cotileas P, Demopoulos V, Voudris V, Pavlides G, Foussas S, Cokkinos D. 2001. Documentation of slow coronary flow by the TIMI frame count in patients with coronary ectasia. The American Journal of Cardiology 88:1030-1032
Pinar Bermúdez E, López Palop R, Lozano Martínez-Luengas I, Cortés Sánchez R, Carrillo Sáez P, Rodríguez Carreras R, Picó Aracil F, Valdés Chávarri M. 2003. Ectasia coronaria: prevalencia, características clínicas y angiográficas. Revista Española de Cardiología 56:473-479.
Pranata R, Yonas E, Chintya V, Alkatiri A. 2019. Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports. International Journal of Angiology 28:231-236.
Robinson F. 1985. Aneurysms of the coronary arteries. American Heart Journal 109:129-135. Sarkar A, Grigg W, Lee J. 2020. TIMI Grade Flow. StatPearls Publishing.
Swanton R, Thomas M, Coltart D, Jenkins B, Webb-Peploe M, Williams B. 1978. Coronary artery ectasia--a variant of occlusive coronary arteriosclerosis. Heart 40:393-400.
Waqas M, Bizzocchi L, Menegus M, Faillace R. 2019. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus 11:e3928.
Yan Q, Ning L, Jian Y, Yang W, Yuan Q, Du Z. 2020. Could the Novel Oral Anticoagulants Be Used for Coronary Artery Aneurysm?. Case Reports in Medicine 2020:1-4.