Disseminated Intravascular Coagulation as a Possible Cause of Acute Coronary Stent Thrombosis: A Case Report and Literature Review

Abstract

Disseminated intravascular coagulation (DIC), as a cause of acute coronary stent thrombosis, has not yet been reported to our knowledge. We report a case of 64-year-old male, who presented with non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography revealed right coronary artery (RCA) stenosis and a drug eluting stent was deployed. Fifteen hours following the intervention, the patient developed an inferior wall ST elevation myocardial infarction. Repeat cardiac catheterization showed an acute in-stent thrombosis. Following thrombectomy, another stent was placed. The patient noted to have an acute drop in platelet count following the second intervention. Two hours following repeat intervention, the patient again developed chest pain and EKG showed recurrent ST-segment elevations in leads II, III, and aVF. Prior to repeat cardiac catheterization, the patient became unresponsive and developed cardiogenic shock. The patient was resuscitated and intubated, and repeat catheterization showed complete stent thrombosis. Intracoronary tissue plasminogen activator (tPA) was given. The platelet count further dropped. Additional studies confirmed the diagnosis of DIC. No further cardiac catheterization was done at this point. The patient then later had a cardiac arrest and unfortunately cardiopulmonary resuscitation could not revive him. Amongst the etiologies of acute stent thrombosis, DIC was deemed a possible cause.

ST-Elevation Myocardial Infarction Precipitated by Disseminated Intravascular Coagulation: A Therapeutic Challenge

“…A few causes of STEMI within the type II MI category may include spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism or potentially thrombosis from a deranged coagulation cascade, as happens in DIC [ 2 , 8 ]. The criteria to diagnose type II MI requires the detection of a rise or fall of cardiac troponin values with at least one value above the 99th percentile and at least one other finding from the following; 1) symptoms of acute myocardial ischemia; 2) new ischemic ECG changes; 3)Development of pathological Q waves; 4)Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology [ 3 ].…”

COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction

“…COVID-19 can be associated with DIC, although this is relatively uncommon [ 9 - 13 ]. DIC results in systemic thrombosis but rarely involves the coronary vessels [ 11 , 14 - 17 ]. A limited number of reports in the literature describe COVID-19-associated DIC presenting as ST-elevation myocardial infarction (STEMI) [ 18 , 19 ].…”

“…These thrombotic events, when severe, can eventually lead to disseminated intravascular coagulation (DIC) [8]. COVID-19 can be associated with DIC, although this is relatively uncommon [9][10][11][12][13].…”