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Reference Manager
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1.
World Health Organization, 2011. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Hemorrhagic Fever. Revised and Expanded Edition. New Delhi, India: Regional Office for South East Asia of the World Health Organization.
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Ministry of Health – Sri Lanka, 2012. Guidelines on Management of Dengue Fever & Dengue Haemorrhagic Fever In Adults. Revised and expanded edition. Colombo, Sri Lanka: Ministry of Health.
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3.
Ehelepola ND, Gunawardhana MB, Sudusinghe TN, Sooriyaarachchi SK, Manchanayake SP, Kalupahana KL, 2016. A dengue infection without bleeding manifestations in an adult with immune thrombocytopenic purpura. Trop Med Health 44: 36.
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Rajapakse S, de Silva NL, Weeratunga P, Rodrigo C, Fernando SD, 2017. Prophylactic and therapeutic interventions for bleeding in dengue: a systematic review. Trans R Soc Trop Med Hyg 111: 433–439.
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Abualsaud AO, Eisenberg MJ, 2010. Perioperative management of patients with drug-eluting stents. JACC Cardiovasc Interv 3: 131–142.
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Byrne RA, Joner M, Kastrati A, 2015. Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J 36: 3320–3331.
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7.
Ghosh SK, Majumder B, Chatterjee S, Ghosh S, Tandel V, 2016. Large hematoma over the puncture site of percutaneous transluminal coronary angioplasty as a presenting sign of severe dengue infection. J Cardiol Cases 14: 139–140.
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8.
Pesaro AE, D’Amico E, Aranha LF, 2007. Dengue: cardiac manifestations and implications in antithrombotic treatment [article in Portuguese]. Arq Bras Cardiol 89: e12–e15.
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Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R, 2012. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141 (2 Suppl): e326S–e350S.
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Lee PT, Liu PY, 2016. TCTAP A-123 platelet activity recovery time is 48 hours slower than the platelet count recovery in hemorrhagic dengue fever subjects. J Am Coll Cardiol 67: S56.
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Weber AA, Braun M, Hohlfeld T, Schwippert B, Tschöpe D, Schrör K, 2001. Recovery of platelet function after discontinuation of clopidogrel treatment in healthy volunteers. Br J Clin Pharmacol 52: 333–336.
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Roy A, Yadav R, Bargava B, Goswami KC, 2007. Rebound thrombocytosis causing MI following dengue fever? Indian Heart J 59: 94.
-
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Orsi FA, Angerami RN, Mazetto BM, Quaino SK, Santiago-Bassora F, Castro V, de Paula EV, Annichino-Bizzacchi JM, 2013. Reduced thrombin formation and excessive fibrinolysis are associated with bleeding complications in patients with dengue fever: a case–control study comparing dengue fever patients with and without bleeding manifestations. BMC Infect Dis 13: 350.
-
15.
Chuang YC, Lin J, Lin YS, Wang S, Yeh TM, 2016. Dengue virus nonstructural protein 1-induced antibodies cross-react with human plasminogen and enhance its activation. J Immunology 196: 1218–1226.
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Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A, 2010. Growing epidemic of coronary heart disease in low-and middle-income countries. Curr Probl Cardiol 35: 72–115.
| Past two years | Past Year | Past 30 Days | |
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| Abstract Views | 403 | 327 | 10 |
| Full Text Views | 856 | 20 | 2 |
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Continuation of Dual Antiplatelet Therapy in a Patient with a Coronary Artery Stent with Dengue Hemorrhagic Fever: A Clinical Conundrum
N. D. B. Ehelepola
N. D. B. Ehelepola
The Teaching (General) Hospital – Kandy, Kandy, Sri Lanka
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A. A. S. D. Athurupana
A. A. S. D. Athurupana
The Teaching (General) Hospital – Kandy, Kandy, Sri Lanka
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P. G. C. S. Bowatte
P. G. C. S. Bowatte
The Teaching (General) Hospital – Kandy, Kandy, Sri Lanka
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Wasantha P. Dissanayake
Wasantha P. Dissanayake
The Teaching (General) Hospital – Kandy, Kandy, Sri Lanka
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Severe thrombocytopenia with impairment of the activity of platelets and impairment of blood clotting occurs in dengue hemorrhagic fever (DHF). Continuation of dual antiplatelet therapy in such patients can result in life-threatening hemorrhages. On the other hand, withholding of antiplatelets in a patient undergone coronary stenting lately can lead to stent thrombosis, resulting in myocardial infarctions and sudden cardiac death. There are no guidelines on management of DHF in patients with coronary stents. Here, we discuss about several divergent factors that need to be considered and balanced when managing such patients. We describe a case as an example to illustrate how we balanced the risk of serious bleeding versus the risk of stent thrombosis successfully according to evolution of the disease process, by temporary withholding of antiplatelets in such a patient.
Author Notes
Disclosure: This is a perspectives article. However, we report clinical data of one patient, and written informed consent from him was obtained. All the information supporting our conclusions and relevant references are included in the manuscript. There are no data sheets related to this article.
Authors’ addresses: N. D. B. Ehelepola, A. A. S. D. Athurupana, P. G. C. S. Bowatte, and Wasantha P. Dissanayake, The Teaching (General) Hospital – Kandy, Kandy, Sri Lanka, E-mails: drehelepola@gmail.com, sajini016@gmail.com, bowattes@gmail.com, and dissanaw@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization, 2011. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Hemorrhagic Fever. Revised and Expanded Edition. New Delhi, India: Regional Office for South East Asia of the World Health Organization.
-
2.
Ministry of Health – Sri Lanka, 2012. Guidelines on Management of Dengue Fever & Dengue Haemorrhagic Fever In Adults. Revised and expanded edition. Colombo, Sri Lanka: Ministry of Health.
-
3.
Ehelepola ND, Gunawardhana MB, Sudusinghe TN, Sooriyaarachchi SK, Manchanayake SP, Kalupahana KL, 2016. A dengue infection without bleeding manifestations in an adult with immune thrombocytopenic purpura. Trop Med Health 44: 36.
-
4.
Rajapakse S, de Silva NL, Weeratunga P, Rodrigo C, Fernando SD, 2017. Prophylactic and therapeutic interventions for bleeding in dengue: a systematic review. Trans R Soc Trop Med Hyg 111: 433–439.
-
5.
Abualsaud AO, Eisenberg MJ, 2010. Perioperative management of patients with drug-eluting stents. JACC Cardiovasc Interv 3: 131–142.
-
6.
Byrne RA, Joner M, Kastrati A, 2015. Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J 36: 3320–3331.
-
7.
Ghosh SK, Majumder B, Chatterjee S, Ghosh S, Tandel V, 2016. Large hematoma over the puncture site of percutaneous transluminal coronary angioplasty as a presenting sign of severe dengue infection. J Cardiol Cases 14: 139–140.
-
8.
Pesaro AE, D’Amico E, Aranha LF, 2007. Dengue: cardiac manifestations and implications in antithrombotic treatment [article in Portuguese]. Arq Bras Cardiol 89: e12–e15.
-
9.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R, 2012. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141 (2 Suppl): e326S–e350S.
-
10.
Lee PT, Liu PY, 2016. TCTAP A-123 platelet activity recovery time is 48 hours slower than the platelet count recovery in hemorrhagic dengue fever subjects. J Am Coll Cardiol 67: S56.
-
11.
Li C, Hirsh J, Xie C, Johnston MA, Eikelboom JW, 2012. Reversal of the anti-platelet effects of aspirin and clopidogrel. J Thromb Haemost 10: 521–528.
-
12.
Weber AA, Braun M, Hohlfeld T, Schwippert B, Tschöpe D, Schrör K, 2001. Recovery of platelet function after discontinuation of clopidogrel treatment in healthy volunteers. Br J Clin Pharmacol 52: 333–336.
-
13.
Roy A, Yadav R, Bargava B, Goswami KC, 2007. Rebound thrombocytosis causing MI following dengue fever? Indian Heart J 59: 94.
-
14.
Orsi FA, Angerami RN, Mazetto BM, Quaino SK, Santiago-Bassora F, Castro V, de Paula EV, Annichino-Bizzacchi JM, 2013. Reduced thrombin formation and excessive fibrinolysis are associated with bleeding complications in patients with dengue fever: a case–control study comparing dengue fever patients with and without bleeding manifestations. BMC Infect Dis 13: 350.
-
15.
Chuang YC, Lin J, Lin YS, Wang S, Yeh TM, 2016. Dengue virus nonstructural protein 1-induced antibodies cross-react with human plasminogen and enhance its activation. J Immunology 196: 1218–1226.
-
16.
Eke S, May SK, 2018. Heparin-induced thrombocytopenia. Medscape. Available at: https://emedicine.medscape.com/article/1357846-overview. Accessed May 24, 2019.
-
17.
Schafer AI, 1995. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol 35: 209–219.
-
18.
Stefanini GG, Holmes DR Jr., 2013. Drug-eluting coronary-artery stents. N Engl J Med 368: 254–265.
-
19.
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, Moyes CL, Farlow AW, Scott TW, Hay SI, 2012. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6: e1760.
-
20.
Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A, 2010. Growing epidemic of coronary heart disease in low-and middle-income countries. Curr Probl Cardiol 35: 72–115.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 403 | 327 | 10 |
| Full Text Views | 856 | 20 | 2 |
| PDF Downloads | 367 | 16 | 2 |