Acute Myocardial Infarction With Vitamin B12 Deficiency and Mild Hyperhomocysteinemia: A Case Report and Review

Abstract

A 38-year-old male was diagnosed with acute myocardial infarction (AMI) without a history of any significant clinical conditions. His subjective complaints and objective findings were clearly suggesting an acute ischemic attack along with vitamin B12 deficiency. While managing him for AMI, serology tests for vitamin B12 revealed low levels along with the mild elevation of serum homocysteine level. He was managed with thrombolytic agent, β-adrenergic blocker, aspirin, antiplatelet agents, anticoagulants, statin, vitamin B complex, and folic acid supplements. The clinical pharmacist intervened by suggesting discontinuation of clopidogrel as two antiplatelet agents (clopidogrel and ticagrelor) were administered along with an anticoagulant, thereby increasing the risk of bleeding in the patient. Clopidogrel was stopped as ticagrelor is a better antiplatelet agent when given in combination with low dose aspirin. Furthermore, aspirin dose was reduced to enhance the efficacy of ticagrelor and provide better secondary prevention for vascular diseases.