Difficulties in managing a patient with acute coronary syndrome, the clinical case

Acute coronary syndrome is characterized by rapid development of the pathological process and a high probability of life-threatening complications, primarily myocardial infarction and cardiogenic shock. The combination of invasive methods and different schemes of antithrombotic therapy is currently an integral part of the treatment of patients with acute coronary syndrome with ST segment elevation. The achievements in the field of drug therapy and interventional methods contributed to an increase in survival rates among patients with fcute coronary syndrome. However, the use of AT, especially in case of combination of different medications, is associated with a number of complications, primarily bleeding. Treatment of patients with severe bleeding includes de-escalation or withdrawal of antiplatelet drugs and blood transfusion, but such actions are associated with high probability of stent thrombosis. Presented clinical case illustrates the objective complexity of antithrombotic therapy selecting in such patients. We highlight the issues arising during the use of antithrombotic therapy in the patient with fcute coronary syndrome, complicated by gastrointestinal bleeding, early stent thrombosis after AT withdrawal and the development of cardiogenic shock. Particular issues of patient management beyond the scope of existing clinical guidelines are considered. It was noted that the lack of clear clinical guidelines for particular cases of managing patients with acute coronary syndrome with a combination of hemorrhagic and thrombotic complications causes difficulties in choosing tactics. Due to the lack of evidencebased medicine data regarding the treatment of cardiogenic shock, there are still a number of questions related to the choice of optimal tactics for inotropic, vasopressor therapy, as well as other aspects of pathogenetic treatment, which requires further research in this area.

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