Intracoronary Thrombus Formation Following Carbon Monoxide Poisoning

Abstract

Thromboembolic events in the context of carbon monoxide (CO) exposure have been well described in the literature. Six cases of clinically significant coronary thrombosis following CO exposure were previously reported. However, factors affecting the development of coronary thrombus in CO exposure are poorly understood, and the significance of this finding in a forensic context is not clear. This article discusses a case of coronary thrombosis found at autopsy following a death in which CO poisoning was suspected. A 67-year-old man was found dead in his garage with four vehicles with their ignition in the "on" position and their tanks empty. At autopsy, severe coronary atherosclerosis and an acute nonocclusive coronary thrombus were found. Given the dissimilarities among cases and the presence of CO exposure, it was suggested that the coronary artery thrombosis is likely due to the inherent prothrombotic mechanism of CO, the only common denominator in all the cases.

Acute carbon monoxide poisoning with low saturation of carboxyhaemoglobin: a forensic retrospective study in Shanghai, China

“…However, in circumstances of low COHb%-related CO poisoning, it always causes disputes due to the unconvincing COHb%. COHb% should not be the mere reliable index in such circumstances since COHb% detection could be negatively affected by multiple factors 12 , 51 , 52 . To address this dilemma, molecular markers might represent an assistant diagnostic technique.…”

“…Multiple case serials have independently reported the existence of acute CO poisoning with low COHb% (refer to Table 1 for details). Ozturk et al reported that a 50-year-old man was referred to the emergency room after exposure to fire smoke and his blood was detected with a COHb level of 20.70% 12 . In an intentional CO poisoning case, the blood COHb level of the victim was 19.30% 13 .…”