Coronary Artery Thromboses, Stent Thrombosis and Antiphospholipid Antibody Syndrome: Case Report

Abstract

The antiphospholipid antibody syndrome (APS) is defined by a state of hypercoagulability secondary to an autoimmune disorder. There are evidences that approximately 2.8-5.5% of cases of acute myocardial infarction (AMI) in young individuals are secondary to APS. In this case report, three coronary artery thromboses occurring within a short period are described. Initially, there was an ST-segment elevation (STEMI) in the presence of coronary artery disease (CAD), with the vessel being treated with stent implantation. Thereafter, a subacute stent thrombosis occurred (high thrombotic load in almost all coronary arteries), which was treated with implantation of two stents. Subsequently, there was a new infarction owing to a new thrombosis in the native coronary artery. The treatment of APS in patients who developed thrombotic events is full anticoagulation from the initial stages maintained throughout life. The standard anticoagulant therapy is administration of vitamin K antagonists, such as warfarin.

Cardiac Manifestations of Antiphospholipid Syndrome With Focus on Its Primary Form

“…AMI in patients with APS usually occurs in the fourth decade of life (57). MI in the young is usually associated with normal or nearly normal coronary angiographic studies (56, 58). In the Euro-phospholipid cohort, which contains the largest series of 1,000 APS patients, there were significantly more MI events in the APS-SLE group (3.8%) compared to the PAPS group (1.2%) over a 10-year follow up period.…”

“…However, aggressive monitoring of traditional risk factors should be performed for lifestyle modification and pharmacological treatment. For CAD, Aspirin prophylaxis was not proven to be an added benefit over warfarin therapy alone (58). Pharmacological therapies include anti-platelets, anticoagulants, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and statin therapy.…”

“…However, recommendations for HCQ use are reported in addition to therapeutic anticoagulation for secondary prevention of arterial thrombotic events in PAPS (57, 113). Therapy with CS in APS-associated ischemic heart disease may be detremental (58). Anticoagulation is optimal with a target INR range of 2.0–3.0 as long term therapy (114, 115), and with escalation to a higher target INR should thrombosis recur (116).…”

Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report

“…Careful surgical techniques are essential, and care must be taken by some basic precautions and intraoperative checks on ostial integrity [11,14]. If after with all these precautions, coronary compromise is detected, many options are available including coronary stenting, device removal, re-replacement with a smaller valve size, coronary graft, and percutaneous coronary intervention [1,15,16]. In our patient, thrombus probably secondary to APS occluded both coronaries' arteries leading to a nearly fatal complication, thankfully the CABG worked, and the patient survived this event.…”

Mixed phenotype cardiomyopathy, associated with DSP genetic variant: a case report and literature review.

“…ИМ был заподозрен клинически (уровень тропонина I в венозной крови 33,900 и >50,000 нг/мл в динамике) и подтвержден при патологоанатомическом исследовании. В литературе представлены описания сочетания НМЛЖ и подострого или острого ИМ 1 типа атерогенного генеза у пациентов старше 45 лет [41][42][43][44][45]. Güvenç TS, et al (2012) описывают клинический случай эмболического ИМ при интактных коронарных артериях по данным КАГ у 20-летнего мужчины с НМЛЖ [46].…”