Effective Management of Acute Coronary Thrombosis in a Young Woman with Lupus Using Aggressive Medical Therapy

Abstract

Systemic lupus erythematosus is a chronic inflammatory disorder that predisposes to acute coronary thrombosis. To demonstrate how the pathophysiology of lupus-mediated coronary events may be unique, we offer the case and management of a young woman with lupus who presented with acute myocardial infarction. She was initially managed with medical therapy including the standard regimen of aspirin, heparin, and clopidogrel. Despite a Thrombolysis in Myocardial Infarction risk score of only 2, she was also given eptifibatide infusion because of clinical concerns. Repeated cardiac catheterization showed marked regression of the thrombus, and coronary fractional flow reserve calculation demonstrated full recovery of coronary vasculature with this therapy. This case demonstrates effective management of life-threatening coronary thrombosis with medical therapy only in a young woman with lupus. We briefly review the pathophysiology of acute coronary thrombosis in lupus patients and distinguish this from the more common process of age-related atherosclerosis. Given the lack of evidence in this specific population, we discuss a pathophysiology-based clinical decision-making tool. Assessing clinical risk factors and using technologies such as intravascular ultrasound can help make the correct treatment decision.

Successful Percutaneous Coronary Intervention in a Young Male Systemic Lupus Erythematosus Patient with Acute Myocardial Infarction

“…For coronary vasospasm treatment with intracoronary nitrate administration can resolve both symptoms of chest pain and angiographic occlusion. 14 In conclusion, our patient with SLE developed AMI twice with different causes. We believe that the best treatment of AMI may be different according to its etiology.…”

Spontaneous coronary artery thrombosis in the setting of active lupus mesenteric vasculitis

“…There is very little evidence to guide the treatment of SLE-related acute coronary syndrome in the absence of coronary disease. 6 Given the concern for a thrombotic origin of MI, we opted for antithrombin therapy in the form of heparin and single antiplatelet therapy with aspirin. We could also not definitely exclude the controversial entity of seronegative APS given his spontaneous coronary arterial thrombosis and deep vein thrombosis, pushing us further towards recommending long-term anticoagulation.…”