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Capecitabine-induced Cardiotoxicity Complicated with Acute Coronary Syndrome and Acute Heart Failure: A Case Report and Review of Scientific Data
(Medicinska Naklada d.o.o., 2025-04)
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Grueva Nastevska, Elena
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Shehu, Enes
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Petkovski, Dushan
Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications. The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications. We present a case of a 46-yearold male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction. Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed. Two months before admission, the patient had undergone surgery for rectal cancer. The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission. The patient clinically deteriorated during the procedure, with development of cardiogenic shock. An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%). Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation. After all these treatment measures, the patient clinically stabilized. He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function. Control echocardiography after 9 days from admission showed an EF of 58%. Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient. The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.
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Generation X- Challenges in anticoagulation
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022-12)
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Doneva, Ana
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Angelova, Aleksandra
Atrial fibrillation (AF) increases an individual’s risk of stroke by 4 to 6 times on average. The risk increases with age. In people over 80 years old, AF is the direct cause of 1 in 4 strokes. In these cases, anticoagulation therapy is recommended for primary prevention and secondary stroke prevention. Direct oral anticoagulants(DOACs) such asRivaroxaban are preferred over Vitamin K antagonists(VKA), according to the latest guidelines.To presentinteresting and challenging cases from the clinical practice and discuss use of Rivaroxaban in primary and secondary prevention in patients with AFand stroke.In November 2022 we organized a two-day workshop, under the auspices of the pharma company Bayer d.o.o. Ljubljana-Representative Office Skopje, Macedonia. Neurology and Cardiologyresidents presented 10 clinical cases, under the mentorship of respective specialists, experts in theirfields. Clinical features, laboratoryanalysis,neuroimaging findings and contemporary management of each case were discussed in detail. Designated mentors presented the latest guidelines and recommendations regarding use of Rivaroxaban in primary and secondary prevention in patients with AFand stroke.Belowwe present 10 clinical cases and describe in detail their physical and neurological condition, laboratory and imaging findings and therapeutic approach

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