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Acute Thrombotic Closure

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Dr Ajay Kumar Mahajan, Mumbai    05 March 2019

  • Carefully watch for catheter-induced dissection as well as dissection at proximal and distal stent edge. Ensure adequate stent expansion and apposition.
  • Consider adjuvant pharmacotherapy like GPIIb/IIa and thrombus aspiration and intracoronary thrombolytic, in case of high thrombotic burden.
  • Ensure adequate pre-treatment with dual antiplatelet. Ensure adequate heparinization.
  • Operator should note time at which heparin is given.
  • Monitor ACT meticulously, repeat heparin, if subtherapeutic ACT.
  • Frequent back bleeding from catheters; ensure that the dye syringe is free of blood. Check and recheck hardware; avoid reuse of hardware.
  • Cath lab should always have drugs like GPIIb/IIa inhibitors, thrombolytics.
  • Suspect in situ catheter thrombus if unexplained pressure damping or failure to back bleed.

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