Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after m...

After stent implantation in the coronary arteries, patients sometimes have to undergo invasive examination or treatments that mandate discontinuation of antiplatelet therapy for several days. We encountered two cases of acute coronary syndrome that occurred after preoperative discontinuation of antiplatelet agents in the chronic phase after stent implantation. In the first case, antiplatelet ag...

Percutaneous coronary intervention with stent placement is one of the most frequently performed procedures in the western world. Patients with coronary stents need to be on dual antiplatelet therapy in order to minimize the risk of stent thrombosis. When these patients undergo surgical procedures, the risk of stent thrombosis needs to be balanced against the risk of bleeding in the perioperativ...

Dual oral antiplatelet therapy, aspirin plus thienopyridine, has permitted a rapid increase in the use of coronary intervention procedures. Clopidogrel is the thienopyridine of choice for dual antiplatelet therapy in patients treated with percutaneous coronary intervention. However, there are two issues with clopidogrel: (1) clopidogrel's antiplatelet activity is delayed because the drug needs ...

Acute lower gastrointestinal bleeding is defined as a bleeding situation in which blood loss has been occurring for less than 3 days resulting in haemodynamic instability, anaemia, or the need for blood transfusion. Diverticula and angiectasias are the most frequent sources of bleeding. Malignancy, inflammatory bowel disease, non-steroidal anti-inflammatory drugs, infectious colitis, ischaemia,...