For coronary perforations, consideration should be given to reversal of anticoagulants, antiplatelet medications and glycoprotein IIb/IIIA inhibitors and an activated clotting time (ACT) should be performed.IIbC
There should be on-site availability and experience with covered stents, embolisation coils and the ability to perform distal embolisation. There should be an agreed unit protocol as to the method of distal embolisation technique as a wide variety of options are available.IIaC
For all cardiac perforations, even if the patient seems stable, a decision must be taken as to whether cardiac surgical colleagues should be consulted. The threshold for surgical discussion should be low. Failure to stop the underlying cause for the tamponade should mandate emergency consultation.IIaC