Successful treatment of post-exertion acute myocardial infarction by primary angioplasty and stenting in a patient with antiphospholipid antibody syndrome

Musuraca, Gerardo; Imperadore, Ferdinando; Terraneo, Clotilde; Girolamo, Piergiuseppe De; Cemin, Claudio; Bonmassari, Roberto; Vergara, Giuseppe

doi:10.1097/00001721-200401000-00015

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Some case reports have documented successful PCI followed by aggressive anticoagulation therapy in APS patients presenting with acute MI. 14) Recurrent stent thrombosis after PCI in APS patients is often treated with CABG. 12) Therefore, the revascularization strategy in patients with APS should be individualized after taking into account the risk of thrombosis, restenosis, and bleeding.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Stent Thrombosis in a Patient with Antiphospholipid Syndrome and Dual Anti-Platelet Therapy Non-Responsiveness

et al. 2015

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Antiphospholipid syndrome (APS), the most common acquired hypercoagulable condition, is diagnosed by persistent presence of antiphospholipid antibodies and episodes of vascular thrombosis. It may be an important predisposing factor for stent thrombosis, resulting in poor outcomes. Also, anti-platelet therapy non-responsiveness is associated with stent thrombosis. We report a case of a 39-year-old man who after undergoing successful percutaneous coronary intervention for significant coronary artery disease suffered repeated stent thrombosis events leading to ST-segment elevation myocardial infarction. Eventually, he underwent coronary artery bypass surgery because of uncontrolled thrombosis and was diagnosed as having APS and dual antiplatelet therapy non-responsiveness.

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Section: Discussionmentioning

confidence: 99%

Recurrent Stent Thrombosis in a Patient with Antiphospholipid Syndrome and Dual Anti-Platelet Therapy Non-Responsiveness

et al. 2015

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“…Therefore patients with APS and coronary acute syndrome have been successfully treated with stents. 15–18…”

Section: Introductionmentioning

confidence: 99%

“…Therefore patients with APS and coronary acute syndrome have been successfully treated with stents. [15][16][17][18] The complications of cardiac stent thrombosis are described in a few case reports. 19,20 To our knowledge this is the first report of mechanical thrombectomy with stent implantation with further therapeutic challenges in a patient with APS and acute stroke.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic challenges after successful thrombectomy in a patient with an antiphospholipid syndrome associated M1-occlusion: A case report

et al. 2015

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Backround Stroke is a frequent disorder in patients with an antiphospholipid syndrome (APS). Due to a high risk for further thromboembolic events, appropriate anticoagulation therapy in patients with an APS-associated stroke seems mandatory but drug eluting and duration is a matter of debate. Case A 48-year-old female patient presented with Broca’s aphasia and mild hemiparesis on the right side. Diagnostic work-up revealed left middle cerebral artery (MCA) occlusion yet without diffusion-weighted lesions. Due to a thrombocytopenia (67.00 g/l) systemic thrombolysis was not indicated and endovascular treatment was initiated 150 min after symptom onset. After successful clot retrieval, recurrent re-occlusions lead to the necessity of stent implantation and anticoagulation, respectively. On day 5 she developed a new severe right-sided hemiparesis. The magnetic resonance imaging (MRI) showed a subtotal restenosis of the left MCA despite the regular anticoagulation regime leading to a new left MCA ischaemic stroke. In the meantime, the unknown aetiology, the patients’ age and the thrombocytopenia let to further diagnostic workup. Elevated blood parameters such as lupus anticoagulant (LA)-1, LA-ratio, positive anti-nuclear antibody (ANA), p-anti-neutrophil cytoplasmic antibodies (ANCA), c-ANCA confirmed the diagnosis of APS. Conclusion This case report showed the feasibility of mechanical clot retrieval and stent implantation in patients with APS. Due to the elevated risk of in-stent thrombosis a prolonged therapy with glycoprotein (GP)IIb/IIIa receptor antagonists in the initial postoperative period and further anticoagulation with coumarin derivate might be needed.

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“…A variety of cardiac affections including valvular lesions, myocardial dysfunction or infarction, early bypass graft failure, and intracardiac thrombosis have been reported [2-4]. Yet in vitro , APL inhibit phospholipid-dependent blood coagulation and bind to membrane phospholipids exposed by stimulated or apoptotic cells [5].…”

Section: Introductionmentioning

confidence: 99%

Elevated levels of procoagulant microparticles in a patient with myocardial infarction, antiphospholipid antibodies and multifocal cardiac thrombosis

et al. 2005

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Circulating procoagulant microparticles (MP) are pathogenic markers of enhanced coagulability associated to a variety of disorders and released from stimulated vascular cells. When derived from endothelial cells, MP were found characteristic of thrombotic propensity in primary antiphospholipid syndrome (APS). The prothrombotic status of a patient with antiphospholipid antibodies (APL), a past history of mesenteric vein thrombosis and presenting myocardial infarction and extensive intracardiac thrombosis was examined by measurement of circulating procoagulant MP. MP of platelet and endothelial origins were highly elevated with respect to values detectable in patients with myocardial infarction and no history of APS (6- and 3-fold elevation, respectively) or in healthy volunteers (13- and 25-fold elevation, respectively). In this particular patient, with moderate APL titer, a drastic release of procoagulant MP could have contributed to thrombus growth and the development of extensive intracardiac thrombosis.

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Successful treatment of post-exertion acute myocardial infarction by primary angioplasty and stenting in a patient with antiphospholipid antibody syndrome

Cited by 5 publications

References 16 publications

Recurrent Stent Thrombosis in a Patient with Antiphospholipid Syndrome and Dual Anti-Platelet Therapy Non-Responsiveness

Recurrent Stent Thrombosis in a Patient with Antiphospholipid Syndrome and Dual Anti-Platelet Therapy Non-Responsiveness

Therapeutic challenges after successful thrombectomy in a patient with an antiphospholipid syndrome associated M1-occlusion: A case report

Elevated levels of procoagulant microparticles in a patient with myocardial infarction, antiphospholipid antibodies and multifocal cardiac thrombosis

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