Development of acute myocardial infarction in a young female patient with essential thrombocythemia treated with anagrelide: a case report

Abstract

Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with a prolonged clinical course. Since this disorder is considered to be at increased risk of thromboembolism, therapy is mainly focused on the decreased risk of thrombohemorrhagic events by use of cytotoxic agents. Anagrelide is a phosphodiesterase III inhibitor which is utilized in the treatment of ET for the reduction of platelets. However, patients treated with anagrelide might experience cardiovascular adverse effects including myocardial infarction (MI), although these events are rare. Herein, we report a case of a 30-year-old female with well controlled ET by anagrelide, who eventually developed an acute non-ST elevation myocardial infarction (MI). There has no found any cardiovascular risk factors in this ET patient, strongly suggesting that anagrelide might be the cause of MI. Therefore, cardiovascular function should be monitored in those patients prescribed with anagrelide.

Anagrelide potentially provokes acute coronary syndrome even in an adolescent affected with essential thrombocythemia concomitant with underlying persistent coronary endothelial dysfunction

“…Relatively young patients (age 30-45) with ET who do not exhibit traditional coronary risk factors (i.e., dyslipidemia, hypertension, smoking, diabetes, and older age) have also been reported to have acute myocardial infarction (AMI) [14][15][16][17] ; however, there is little information on the incidence of AMI among patients younger than 20 years, with few reports on such cases. 18 The mechanisms underlying acute coronary syndrome are considered to be multifactorial.…”

Calreticulin Mutated Essential Thrombocythemia Presenting as Acute Coronary Syndrome

“…The combination of hydroxyurea and aspirin is an accepted treatment strategy for patients at high risk of thrombosis [ 3 ]. Anagrelide, due to its increased risk of arterial thrombosis when compared to hydroxyurea [ 10 ], as well as rare but serious cardiovascular side effects including ACS, limits its use in patients with ET and ACS [ 17 , 18 ].…”

A Young Male with a Non-ST Elevation Myocardial Infarction and Polycythemia Vera

“…Limited information exists about the association of NSTEMI to myeloproliferative neoplasms, despite it has been reported in literature (22)(23)(24)(25)(26), when present, it tends to be associated with multiple atherosclerotic risk factors. Up to our knowledge, our case is the rst young patient without cardiovascular risk factors who presented with NSTEMI in PV literature, however, there are few cases reported with ET (22)(23)(24)(25)(26). His presentation was subacute with only minimal rise in troponins and dynamic ECG changes that concur with the diagnosis of NSTEMI, he had transient ST elevation which does not t with the pattern of STEMI.…”