PMID- 34758435
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211119
IS  - 2210-2612 (Print)
IS  - 2210-2612 (Electronic)
IS  - 2210-2612 (Linking)
VI  - 88
DP  - 2021 Nov
TI  - A case report of atraumatic splenic rupture after coronary stenting and dual 
      antiplatelet therapy: Causality or relationship?
PG  - 106578
LID - S2210-2612(21)01080-4 [pii]
LID - 10.1016/j.ijscr.2021.106578 [doi]
LID - 106578
AB  - INTRODUCTION AND IMPORTANCE: Atraumatic splenic rupture(ASR) is a rare event with 
      challenging management, due to absence of clinical history of trauma and delayed 
      diagnosis. Current clinical report could provide detailed information regarding 
      clinical presentation and management to physicians. CASE PRESENTATION: A 
      61 years-old woman underwent percutaneous coronary intervention(PTCA) after ST 
      elevation myocardial infarction(STEMI). In the first day after PTCA epigastric 
      abdominal disconfort was reported, and new PTCA excluded early complication. 
      During hospitalization, due to anemization and hypotension CT scan was performed 
      which revealed ASR with large hemoperitoneum. Emergency surgical splenectomy was 
      performed. Postoperative course was uneventful and patient started 90 mg 
      Ticageclor twice daily in the first post-operative day(POD) plus low molecular 
      weight Heparin and restarted dual antiplatelet therapy(DAPT) the seventh POD. 
      During follow up, patient underwent to assessment of platelet function showing 
      normal level of DAPT inhibition. Due to the lack of pathological aggregation 
      activity, DAPT was maintained. CLINICAL DISCUSSION: ASR is mainly linked to 
      oncological, malformative, inflammatory and thromboembolic conditions. Despite 
      anticoagulant and anti-aggregating drug-related ASR has been already described, 
      we report the first case of drug-related ASR as immediate complication of PTCA 
      due to DAPT. After surgery, careful anti-aggregating management was required to 
      balance in stent restenosis and hemorragic risk. Assessment of platelet activity 
      was performed to design a tailored anti-aggregating therapy. CONCLUSION: 
      Drug-related ASR is dangerous complication due to the high mortality rate and 
      misleading symptoms. After major bleeding events, such as drug-related ASR, 
      evaluation of platelet function could provide a tailored DAPT.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Boccanelli, Paolo
AU  - Boccanelli P
AD  - Department of General and Emergency Surgery, University of Tor Vergata, Viale 
      Oxford 81, 00133 Rome (RM), Italy.
FAU - Materazzo, Marco
AU  - Materazzo M
AD  - Department of General and Emergency Surgery, University of Tor Vergata, Viale 
      Oxford 81, 00133 Rome (RM), Italy. Electronic address: mrcmaterazzo@gmail.com.
FAU - Venditti, Dario
AU  - Venditti D
AD  - Department of General and Emergency Surgery, University of Tor Vergata, Viale 
      Oxford 81, 00133 Rome (RM), Italy. Electronic address: 
      dario.venditti@uniroma2.it.
FAU - Pellicciaro, Marco
AU  - Pellicciaro M
AD  - Department of General and Emergency Surgery, University of Tor Vergata, Viale 
      Oxford 81, 00133 Rome (RM), Italy.
FAU - Santori, Francesca
AU  - Santori F
AD  - Department of General and Emergency Surgery, University of Tor Vergata, Viale 
      Oxford 81, 00133 Rome (RM), Italy.
FAU - Grande, Michele
AU  - Grande M
AD  - Department of General and Emergency Surgery, University of Tor Vergata, Viale 
      Oxford 81, 00133 Rome (RM), Italy. Electronic address: 
      michele.grande@ptvonline.it.
LA  - eng
PT  - Journal Article
DEP - 20211106
PL  - Netherlands
TA  - Int J Surg Case Rep
JT  - International journal of surgery case reports
JID - 101529872
PMC - PMC8581366
OTO - NOTNLM
OT  - Case report
OT  - Dual anti-platelet therapy
OT  - Percutaneous coronary intervention
OT  - ST elevation myocardial infarction
OT  - Splenic rupture
EDAT- 2021/11/11 06:00
MHDA- 2021/11/11 06:01
PMCR- 2021/11/06
CRDT- 2021/11/10 20:11
PHST- 2021/09/19 00:00 [received]
PHST- 2021/11/01 00:00 [revised]
PHST- 2021/11/01 00:00 [accepted]
PHST- 2021/11/11 06:00 [pubmed]
PHST- 2021/11/11 06:01 [medline]
PHST- 2021/11/10 20:11 [entrez]
PHST- 2021/11/06 00:00 [pmc-release]
AID - S2210-2612(21)01080-4 [pii]
AID - 106578 [pii]
AID - 10.1016/j.ijscr.2021.106578 [doi]
PST - ppublish
SO  - Int J Surg Case Rep. 2021 Nov;88:106578. doi: 10.1016/j.ijscr.2021.106578. Epub 
      2021 Nov 6.