Background: Most of the primary percutaneous coronary interventions (PPCI) for ST-elevation myocardial infarction (STEMI) in young patients are not associated with major complications.However, in patients with complications such as hyperacute stent thrombosis or lack of response to anticoagulant therapy, other underlying causes such as thrombophilia must be suspected. Case summary: A 51-year-old male patient with cardiovascular risk factors who presented with chest pain and Killip class II anterior STEMI. PPCI time was >120 minutes and fibrinolytic strategy failed. He was switched to rescue PCI. Cardiac catheterization showed atherothrombotic occlusion in the proximal left anterior descending artery. PCI was performed with balloon angioplasty and 2 overlapping drug-eluting stents were implanted. Despite administration of 10,000 IU of unfractionated heparin + 100 mg of enoxaparin in a 65-kg patient, the activated clotting time (ACT) did not increase above 250. In the last injections there was an image of repletion contrast defect in the proximal segment of the stent with thrombus material that suggested non-occlusive hyperacute stent thrombosis. A switch to prasugrel and abciximab perfusion was performed. During his hospital stay, a coagulopathy workup was performed, which evidenced elevated factor VIII; the rest of the results were normal. Discussion: The presence of thrombophilic disorders such as elevated factor VIII in patients undergoing PCI increases the risk of complications during the procedure. In young patients undergoing PCI, thrombophilia should be suspected as a cause of complications and a full study should be performed.
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