Background
Acute and subacute stent thromboses are a rare complication associated with high mortality and morbidity occurring in about 1.5% of patients treated with primary percutaneous intervention for ST elevation myocardial infarction (STEMI). Recent publications describe a potential role of von Willebrand factor (VWF) in thrombus formation at sites of critical coronary stenosis in STEMI.
Case Summary
We describe a 58-year-old woman with STEMI at initial presentation, who suffered subacute stent thrombosis despite good stent expansion, efficacious dual antiplatelet therapy, and therapeutic anticoagulation. Because of very high VWF values, we initiated N-acetyl-cysteine in order to depolymerise VWF, but the drug was not well tolerated. Since the patient was still symptomatic, we administered caplacizumab in order to prevent VWF from interacting with platelets. Under this treatment, the clinical and angiographic course was favourable.
Discussion
Considering a modern view of intracoronary thrombus pathophysiology, we describe an innovative treatment approach, which eventually ended in a favourable outcome.
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