One case of recurrent ST-segment elevation myocardial infarction in a patient with antiphospholipid syndrome complicated with severe thrombocytopenia within a short period of time: A case report

Abstract

Introduction: Acute myocardial infarction is an important arterial thrombotic event in patients with antiphospholipid syndrome (APS). Anticoagulation regimen might greatly affect the prognosis. Due to the lack of sufficient data and large prospective randomized controlled trials, there is no definite consensus among researchers on the optimal antithrombotic therapy for patients with APS after arterial events. Patient concerns: A 35-year-old male presented with sustained chest tightness and chest pain for 6 hours, accompanied with palpitation, sweating and headache. Diagnosis: The patients was diagnosed with acute ST-segment elevation myocardial infarctions with severe thrombocytopenia. Emergency coronary angiography showed that the posterior descending artery (PDA) was occluded, and a thrombus shadow was visible. An emergency coronary intervention was performed to open the occluded PDA. About 48 hours after hospitalization, the PDA was occluded again and percutaneous coronary intervention was performed again to open the blocked coronary artery. The lupus anticoagulant screen rate were positive during hospitalization and 12 weeks after discharge, meeting the diagnostic criteria of APS. Interventions: The patient received coronary intervention twice during hospitalization. After the second coronary intervention, a sequential therapy of bivalirudin, fondaparinux sodium, and warfarin was adopted as the anticoagulant regimen. Outcomes: The patient was discharged in stable condition without chest pain. One year later, during her follow-up, a repeat echocardiogram and electrocardiogram showed normal findings. Conclusion: It is the first report of severe thrombocytopenia and recurrent coronary thrombosis within a short period of time in an APS patient, and in this report the importance of anticoagulant therapy in thrombus management in patients with APS was present, also the importance of tracking thrombotic factors. This study proposes an anticoagulation regimen for patients suffering from antiphospholipid syndrome, experiencing recurrent atherothrombotic events, and presenting severe thrombocytopenia.