Journal of Clinical Case Reports

Patient with Large Liver Tumor, Bleeding Ulcer and Unstable Angina Treated with Coronary Stenting Followed by Portal Embolization and Major Liver Surgery with Ticagrelor and Aggrastat Prophylaxis

Abstract

Per Sandstrom, Thomas Gasslander, Bergthor Björnsson, Rickard Bohnmark, Anna Holm, Thomas Muhr and Sofia Sederholm Lawesson

Background: There is very little data in the literature on how to handle Dual Antiplatelet Therapy (DAPT) and newly adapted Drug Eluting Stents (DES) in patients in need of liver surgery due to malignant disease.

Case report: A man, 79 years of age, with a bleeding hepatocellular carcinoma in a normal liver, bleeding duodenal ulcer and Acute Coronary Syndrome (ACS). Coronary angiography showed significant stenoses in the left main coronary artery (LM), Left Anterior Descending (LAD), first and second diagonal branches (D1, D2), Circumflex (Cx) and Right Coronary Artery (RCA). The patient was treated with Percutaneous Coronary Intervention (PCI) including six everolimus eluting coronary stents, aspirin and ticagrelor followed by portal embolization two months after stenting and another two months later liver resection, bridging with the Glycoprotein Receptor Inhibitor (GPI) tirofiban. The portal embolization was uneventful but there were bleeding complications after liver surgery, calling for very close monitoring of the antithrombotic treatment under these complex conditions.

Discussion: Close monitoring and individualization of therapy was essential to make portal embolization and liver tumor surgery possible in this patient with DES and DAPT.

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