Se presenta el caso de paciente femenina de 47 años de edad, originaria y residente de la ciudad de Manizales, Caldas, Colombia, que inicia con cuadro clínico de dolor precordial opresivo, posterior ...a una discusión familiar, presentando cambios electrocardiográficos en el segmento ST en cara anteroseptal, cardioenzimas positivas, hallazgos ecocardiográficos y angiográficos compatibles con cardiomiopatía de Takotsubo. Dada la dificultad para su diagnóstico y la posibilidad de confundirse con otras etiologías (etiologías de cuadros clínicos similares), exponemos este reporte de caso para invitar al lector a pensar en esta patología como un posible diagnóstico y destacar sus características clínicas identificarlo y tratarlo a tiempo. Palabras clave: Cardiomiopatía de Takotsubo, estrés, dolor torácico. Here we present the case of 47-year-old female patient, native and resident of the city of Manizales, Caldas, Colombia, who started with a clinical picture of oppressive precordial pain, after a family argument, presenting electrocardiographic changes in the ST segment in anteroseptal face, positive cardioenzymes, echocardiography and angiography compatible with Takotsubo cardiomyopathy. Given the difficulty of its diagnosis and the possibility of being confused with other aetiologies (aetiologies of similar clinical pictures), we present this case report to invite the reader to think of this pathology as a possible diagnosis and highlight its clinical characteristics, identify it and treat it in time . Keywords: Takotsubo cardiomyopathy, stress, chest pain.
Clopidogrel is an effective purinergic 2Y
receptor (P2Y
) antagonist used to prevent arterial thrombosis, but its use is associated with adverse bleeding. Clinical studies have demonstrated that ...clopidogrel users have an increased risk of cerebral microbleeds and intracerebral hemorrhage. Our previous studies suggest that non-platelet mechanisms mediate these adverse bleeding events; we hypothesize that clopidogrel or one of its metabolites interacts with blood vessels directly to cause bleeding. New Zealand white rabbits (1.9-2.7 kg) were treated orally with vehicle or clopidogrel (3 or 10 mg/kg) for three days. On the fourth day, the rabbits were anesthetized for blood collection and then euthanized. The brain was collected, and the middle cerebral arteries were isolated. We used light transmission aggregometry and pressure myography to elucidate the mechanisms of the off-target effects associated with clopidogrel treatment. We confirmed that inhibition of P2Y
activation by clopidogrel inhibited ADP-induced platelet aggregation but had no impact on P2Y
-independent arachidonic acid- or collagen-induced platelet aggregation. Analysis of middle cerebral arteries from clopidogrel treated rabbits showed that clopidogrel did not affect P2Y
, P2Y
, and P2Y
receptor-mediated contraction but attenuated the contractile response after P2Y
receptor activation. Further analysis determined P2Y
-mediated constriction was endothelium-dependent. Vasoconstriction is a primary component of hemostasis, and impaired vasoconstriction can prolong bleeding. These results suggest clopidogrel inhibits the endothelial P2Y
receptor in the middle cerebral artery, which provides a mechanistic explanation for the adverse cerebral bleeding associated with the drug.
Patients who had undergone successful TAVR were randomly assigned to receive either a rivaroxaban-based antithrombotic regimen or an antiplatelet-based antithrombotic regimen. At 17 months, the ...primary outcome of death or thromboembolic complications occurred more frequently with rivaroxaban.
In a trial, patients who had undergone successful TAVR were assigned to rivaroxaban or antiplatelet therapy. In this substudy in patients who underwent CT, leaflet thickening and reduced leaflet ...motion at 90 days were less common with rivaroxaban. However, in the main trial, rivaroxaban was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding.
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