Recurrent acute coronary events in a patient with primary antiphospholipid syndrome: successful management with intracoronary stenting

Life-threatening cardiac manifestations of primary antiphospholipid syndrome

We report a rare case of primary antiphospholipid syndrome (APS) in a 43-year-old man presenting as recurrent acute coronary stent thrombosis and complicated by three myocardial infarctions. As illustrated in this report, in APS patients recurrent life-threatening arterial thrombotic events may occur in spite of recommended anticoagulant therapy. We conclude that the APS should be considered as a potential cause of acute coronary syndrome, particularly in young individuals with a history of recurrent thrombotic events and/or with abnormal coagulation test results. Further studies are needed to determine the best therapeutic strategy for APS patients with acute coronary syndrome.

Very late stent thrombosis after drug-eluting stent implantation in a patient with antiphospholipid syndrome

A 74-year-old woman was admitted to our hospital with chest pain and shortness of breath. Coronary arteriograms revealed occlusion of a drug-eluting stent, which had been implanted 33 months earlier, in the middle right coronary artery. During percutaneous coronary intervention, distal embolization developed and a thrombus was detected with an aspiration catheter. Serological examinations performed 1 year before and during the present hospitalization revealed positive lupus anticoagulant activity. Thrombophilic tendencies, such as antiphospholipid syndrome, are noteworthy as one of the causative factors in very late stent thrombosis.

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

Antiphospholipid syndrome is a disorder characterized by arterial and venous thromboses, thrombocytopaenia and stroke. Acute myocardial infarction is rarely associated with this syndrome. The treatment of these patients is a clinical challenge. This report is about a patient with antiphospholipid syndrome presenting with an acute myocardial infarction after an exercise test. The infarct-related coronary artery was successfully revascularized by primary angioplasty and stenting without any major bleeding complications. We think that the physical exertion could have favoured acute coronary thrombosis in this particular setting.

Coronary and valvular syndromes and antiphospholipid antibodies

Since the recognition of the antiphospholipid syndrome (APS), a large number of cardiac manifestations have been reported in association with these antibodies, including coronary artery and valvular disease, cardiomyopathy, and intracardiac thrombosis. Most of these manifestations are explicable on the basis of thrombotic lesions either in the coronary circulation or on the valves and may mimic other similar conditions, such as rheumatic fever or infectious endocarditis. The APS coagulopathy in these patients requires the careful and judicious use of appropriate antiaggregant and anticoagulant therapy. In this review article, the focus will be on the main cardiac features related to the presence of antiphospholipid antibodies (aPLs), which may be of interest to clinicians.

Acute thrombosis after elective direct intracoronary stenting in primary antiphospholipid syndrome: a case report

Antiphospholipid syndrome (APS) is an uncommon prothrombotic disorder that has been increasingly recognized in recent years. The diagnosis of APS must be associated with venous or arterial thrombosis or both. Patients with APS usually present with recurrent deep vein thrombosis, pulmonary thromboembolism, thromboembolic stroke, or myocardial infarction. Here, we report a case of a 61-year-old female who presented with a 3-month history of increasingly frequent retrosternal chest tightness. After treadmill test and thallium-201 myocardial perfusion scan, she was admitted and underwent elective coronary angiography but developed acute thrombosis after direct intracoronary stenting. She was successfully rescued with repeat percutaneous transluminal coronary angioplasty and prolonged heparin and glycoprotein IIb/IIIa antagonist use. Laboratory data showed prolongation of partial thromboplastin time and positive anti-cardiolipin antibody. These findings satisfied the criteria for APS; the patient was diagnosed with primary APS because she had neither typical symptoms nor signs of systemic lupus erythematosus or other immunologic disorders. Thereafter, long-term oral anticoagulant appeared to be effective. To our knowledge, this is the first report of acute stent thrombosis in a patient with primary APS.

Successful primary angioplasty in Hughes syndrome

Acute myocardial infarction is a well-recognized complication of the Hughes syndrome but its optimal treatment is uncertain. We report a case of a 42-year-old man with a history of previous arterial and venous thrombosis who presented with an acute myocardial infarction that was successfully treated by primary angioplasty and stenting.

Successful catheter intervention for acute coronary syndrome in a patient with antiphospholipid syndrome

Antiphospholipid syndrome (APS) has the clinical manifestations of systemic vascular thrombotic disorders. Although coronary events are infrequent, they have been described. Early coronary interventions and vein graft bypass frequently failed because of thrombosis. Here we present a case of successful coronary intervention and management of acute coronary syndrome under a strictly controlled coagulation state in an APS patient.