Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge
In recent years, there has been a clear trend towards an increase in the number of elderly patients suffering from several polymorbid diseases, which considerably complicates the forecast and tactics of management. A clinical case of an elderly patient, suffering for a long time from type 2 diabetes...
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| Format: | Article |
| Language: | English |
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Столичная издательская компания
2018-09-01
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| Series: | Рациональная фармакотерапия в кардиологии |
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| Online Access: | https://www.rpcardio.online/jour/article/view/1721 |
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| author | M. R. Atabegashvili M. Yu. Gilyarov E. V. Konstantinova A. N. Kostina A. P. Nesterov T. D. Pakharkova A. E. Udovichenko |
| author_facet | M. R. Atabegashvili M. Yu. Gilyarov E. V. Konstantinova A. N. Kostina A. P. Nesterov T. D. Pakharkova A. E. Udovichenko |
| author_sort | M. R. Atabegashvili |
| collection | DOAJ |
| description | In recent years, there has been a clear trend towards an increase in the number of elderly patients suffering from several polymorbid diseases, which considerably complicates the forecast and tactics of management. A clinical case of an elderly patient, suffering for a long time from type 2 diabetes mellitus, receiving insulin and treated with programmed hemodialysis due to terminal chronic renal failure, and suffering from atrial fibrillation in permanent form, is presented. The patient was hospitalized in theCityClinicalHospital№1 named after N.I. Pirogov due to acute repeated myocardial infarction. An emergency percutaneous coronary intervention was performed, the infarct-dependent artery was stented with a drug-eluted stent. The postoperative period complicated by the development of acute blood loss associated with bleeding from the upper sections of the gastrointestinal tract, and severe anemia of the combined genesis (posthemorrhagic, renal). This situation required doctors to make non-standard decisions in the choice of antithrombotic therapy. This clinical case illustrates the difficulties in elderly polymorbid patient management in real clinical practice and the controversial issues arising in the prescribing the antithrombotic therapy, especially after bleeding had developed. The supporting guidelines cannot answer all the questions which the daily practice poses to the doctor. In each case, the resumption of antithrombotic therapy and its optimal choice for an elderly polymorbid patient with developed bleeding is the subject of discussion and presented a real challenge for the treating physician. |
| format | Article |
| id | doaj-art-73a7a65a34e04c2c8285e629478043e0 |
| institution | Kabale University |
| issn | 1819-6446 2225-3653 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj-art-73a7a65a34e04c2c8285e629478043e02025-08-23T10:00:29ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532018-09-0114452452810.20996/1819-6446-2018-14-4-524-5281503Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time ChallengeM. R. Atabegashvili0M. Yu. Gilyarov1E. V. Konstantinova2A. N. Kostina3A. P. Nesterov4T. D. Pakharkova5A. E. Udovichenko6City Clinical Hospital №1 named after N.I. PirogovCity Clinical Hospital №1 named after N.I. Pirogov; I.M. Sechenov First Moscow State Medical University (Sechenov University)City Clinical Hospital №1 named after N.I. Pirogov; Pirogov Russian National Research Medical UniversityI.M. Sechenov First Moscow State Medical University (Sechenov University)City Clinical Hospital №1 named after N.I. PirogovI.M. Sechenov First Moscow State Medical University (Sechenov University)City Clinical Hospital №1 named after N.I. Pirogov; I.M. Sechenov First Moscow State Medical University (Sechenov University)In recent years, there has been a clear trend towards an increase in the number of elderly patients suffering from several polymorbid diseases, which considerably complicates the forecast and tactics of management. A clinical case of an elderly patient, suffering for a long time from type 2 diabetes mellitus, receiving insulin and treated with programmed hemodialysis due to terminal chronic renal failure, and suffering from atrial fibrillation in permanent form, is presented. The patient was hospitalized in theCityClinicalHospital№1 named after N.I. Pirogov due to acute repeated myocardial infarction. An emergency percutaneous coronary intervention was performed, the infarct-dependent artery was stented with a drug-eluted stent. The postoperative period complicated by the development of acute blood loss associated with bleeding from the upper sections of the gastrointestinal tract, and severe anemia of the combined genesis (posthemorrhagic, renal). This situation required doctors to make non-standard decisions in the choice of antithrombotic therapy. This clinical case illustrates the difficulties in elderly polymorbid patient management in real clinical practice and the controversial issues arising in the prescribing the antithrombotic therapy, especially after bleeding had developed. The supporting guidelines cannot answer all the questions which the daily practice poses to the doctor. In each case, the resumption of antithrombotic therapy and its optimal choice for an elderly polymorbid patient with developed bleeding is the subject of discussion and presented a real challenge for the treating physician.https://www.rpcardio.online/jour/article/view/1721elderly patientacute coronary syndromepercutaneous coronary interventionrenal dysfunctionhemodialysisatrial fibrillationantithrombotic therapybleedingsafety of treatment |
| spellingShingle | M. R. Atabegashvili M. Yu. Gilyarov E. V. Konstantinova A. N. Kostina A. P. Nesterov T. D. Pakharkova A. E. Udovichenko Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge Рациональная фармакотерапия в кардиологии elderly patient acute coronary syndrome percutaneous coronary intervention renal dysfunction hemodialysis atrial fibrillation antithrombotic therapy bleeding safety of treatment |
| title | Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge |
| title_full | Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge |
| title_fullStr | Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge |
| title_full_unstemmed | Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge |
| title_short | Antithrombotic Therapy after Bleeding in Elderly Polimorbid Patient: Our Time Challenge |
| title_sort | antithrombotic therapy after bleeding in elderly polimorbid patient our time challenge |
| topic | elderly patient acute coronary syndrome percutaneous coronary intervention renal dysfunction hemodialysis atrial fibrillation antithrombotic therapy bleeding safety of treatment |
| url | https://www.rpcardio.online/jour/article/view/1721 |
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