A case report of atraumatic splenic rupture after coronary stenting and dual antiplatelet therapy: Causality or relationship?

Paolo Boccanelli; Marco Materazzo; Dario Venditti; Marco Pellicciaro; Francesca Santori; Michele Grande

doi:10.1016/j.ijscr.2021.106578

A case report of atraumatic splenic rupture after coronary stenting and dual antiplatelet therapy: Causality or relationship?

Int J Surg Case Rep. 2021 Nov:88:106578. doi: 10.1016/j.ijscr.2021.106578. Epub 2021 Nov 6.

Authors

Paolo Boccanelli¹, Marco Materazzo², Dario Venditti³, Marco Pellicciaro¹, Francesca Santori¹, Michele Grande⁴

Affiliations

¹ Department of General and Emergency Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome (RM), Italy.
² Department of General and Emergency Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome (RM), Italy. Electronic address: mrcmaterazzo@gmail.com.
³ Department of General and Emergency Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome (RM), Italy. Electronic address: dario.venditti@uniroma2.it.
⁴ Department of General and Emergency Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome (RM), Italy. Electronic address: michele.grande@ptvonline.it.

Abstract

Introduction and importance: Atraumatic splenic rupture(ASR) is a rare event with challenging management, due to absence of clinical history of trauma and delayed diagnosis. Current clinical report could provide detailed information regarding clinical presentation and management to physicians.

Case presentation: A 61 years-old woman underwent percutaneous coronary intervention(PTCA) after ST elevation myocardial infarction(STEMI). In the first day after PTCA epigastric abdominal disconfort was reported, and new PTCA excluded early complication. During hospitalization, due to anemization and hypotension CT scan was performed which revealed ASR with large hemoperitoneum. Emergency surgical splenectomy was performed. Postoperative course was uneventful and patient started 90 mg Ticageclor twice daily in the first post-operative day(POD) plus low molecular weight Heparin and restarted dual antiplatelet therapy(DAPT) the seventh POD. During follow up, patient underwent to assessment of platelet function showing normal level of DAPT inhibition. Due to the lack of pathological aggregation activity, DAPT was maintained.

Clinical discussion: ASR is mainly linked to oncological, malformative, inflammatory and thromboembolic conditions. Despite anticoagulant and anti-aggregating drug-related ASR has been already described, we report the first case of drug-related ASR as immediate complication of PTCA due to DAPT. After surgery, careful anti-aggregating management was required to balance in stent restenosis and hemorragic risk. Assessment of platelet activity was performed to design a tailored anti-aggregating therapy.

Conclusion: Drug-related ASR is dangerous complication due to the high mortality rate and misleading symptoms. After major bleeding events, such as drug-related ASR, evaluation of platelet function could provide a tailored DAPT.

Keywords: Case report; Dual anti-platelet therapy; Percutaneous coronary intervention; ST elevation myocardial infarction; Splenic rupture.