Abrupt back pain in patient Back painright after

Abrupt back pain in patient Back painright after one month of PCI treated with PCI before a month Hanil General Hospital Cardiology Ji-Yeon Hong

JI-YEON HONG, M. D. , Ph. D I have no relevant financial relationships

C/C Chest pain (M/55) Onset) remote 5 YA Unstable angina recent 7 DA : aspirin + brilinta® + B-blocker + statin Mode) during sleep Ass Sx. ) diaphoresis (+), radiating pain to Lt arm HTN/DM/dyslipidemia (+/-/-) : amlodipine 2. 5 mg + atenolol 50 mg + chlorohthalidone 12. 5 mg Current smoker (20 PYS) and heavy drinker V/S 150/80 mm. Hg HR 78 bpm RR 20/min

Initial CXR, ECG & lab • Cardiac marker : WNL • Lipid profile : 140 -410 -52 -18. 9

Echocardiography

CAG

PCI in LAD LAXA® 2. 5 X 20 mm Biomatrix 2. 5 X 24 mm

HD#3 Discharge Medication) Astrix® (Aspirin) 100 mg Brilinta® (Ticagrelor) 90 mg bid Concor® (Bisoprolol) 2. 5 mg 0. 5 t Zanidip® (Lercanidipine) 10 mg Crestor® (Rosuvastatin) 20 mg

He visited ER with back pain after a month s) Abrupt pain and bruise in Rt chest wall and Rt. back pain (1 DA) Denial of trauma Hx. • Cardiac marker (-) • Hb 10. 0 <- previous 14. 6 ( 1 month ago)

Chest CT- coronal view

Chest CT - Sagittal view 1. Stop aspirin and ticagrelor 2. Administer FFP 3. Angiography

Emergent Angiography 1. Rt lateral thoracic arteriography was done. 2. Multiple rt intercostal arteriographies were done. 3. No active bleeding was seen.

Recheck Chest CT – bone setting view • Large intermuscular hematoma at right lateral chest wall • Suspicious fracture at right 4 -10 th ribs !! Large intermuscular hematoma at Rt. lateral chest wall due to trauma

Conclusion v Large intermuscular hematoma at Rt. lateral chest wall due to rib fracture aspirin + ticagrelor stop Stop medication due to epistaxis (during 1 month) aspirin + clopidogrel restart : There was no bleeding event thereafter

Ticagrelor Vs. Clopidogrel in Asian (PLATO Study)

Take Home Message • Ticagrelor – The direct-acting, potent, fast-acting P 2 Y 12 inhibitor – recommended for moderate to high-risk patients with ACS – PLATO study • superior efficacy compared with clopidogrel in reducing cardiovascular events and mortality, at the expense of an increase in major bleeding not related to coronary artery bypass graft (CABG) surgery. • ? Safety of ticagrelor compared with clopidogrel in real-world? – Bleeding event in patients using ticagrelor after PCI should be always considered!!

Thank you for attention

Comparison between initial CXR & F/U CXR