Trombosis coronaria recurrente, síndrome antifosfolipídico primario, factor V Leiden y virus de la inmunodeficiencia humana

A Review of Systemic Hematological Manifestations and Stent Thrombosis

Stent thrombosis (ST) has significant morbidity and mortality following percutaneous coronary intervention (PCI). ST is uncommon making the identification of nonprocedural predictors challenging. Numerous case reports of ST in both benign and malignant hematological conditions exist. Given ST could be a Herald event of an undiagnosed condition and condition-specific treatment may be available, it is important to consider specialist testing in an unexplained ST. This review included a case presentation of ST in previously undiagnosed paroxysmal nocturnal hemoglobinuria (PNH) and a literature review of ST in other acquired thrombophilias including myeloproliferative disorders (MPNs), antiphospholipid syndrome, hematological malignancies, and heparin-induced thrombocytopenia (HIT). Inherited thrombophilias and common pitfalls in thrombophilia and coagulation testing are also discussed. The cardiac-hematology landscape is becoming increasingly complex and there is a paucity of how to best manage ST in these patients. There is clear variability in practice and the use of multidisciplinary input between cardiologists and hematologists is essential.

Multimodal computed tomography-guided intravenous rtPA for aborted stroke in a HIV-infected young man: a case report

Background

Human immunodeficiency virus (HIV) infection has been recognized as a risk factor for both ischemic and hemorrhagic stroke among young adults. However, information on the optimal management of HIV patients presenting with presumed acute ischemic stroke within the time window of intravenous recombinant tissue plasminogen activator (IV-rtPA) thrombolysis is limited. To the best of our knowledge, the use of multimodal computed tomography (CT)-based imaging to guide acute-phase treatment for patients with HIV infection has never been reported.

Case presentation

We report the clinical, imaging, and immunological features of a young man suffering from presumed acute ischemic stroke, initially without awareness of the presence of HIV infection. IV-rtPA guided by multimodal CT, including brain CT angiography (CTA) and CT perfusion (CTP), was administered at the emergency department. His symptoms were relieved, and there was no recurrence during the 2-month follow up.

Conclusions

Mutimodal CT is a valuable and promising tool for the early management of HIV-infected patients, especially for those presenting within the strict thrombolysis time window.

Ischemic Heart Disease in HIV: An In-depth Look at Cardiovascular Risk

Although the incidence of cardiovascular diseases classically associated with human immunodeficiency virus (HIV) has decreased considerably with antiretroviral therapy, cardiovascular risk, and especially ischemic heart disease, are higher in HIV-infected patients than in uninfected individuals. This is due to the interaction of patient-dependent factors with virus-dependent factors, as well as factors associated with antiretroviral therapy. With increasing of life expectancy and the chronicity of HIV infection, cardiovascular disease has emerged as an important cause of morbidity and mortality in HIV patients. In developed countries, the most common cardiovascular manifestation of HIV is ischemic heart disease. Currently, it is not uncommon to find HIV patients with acute coronary syndrome and, given the important pharmacokinetic interactions of antiretroviral drugs, it is important to know which cardiovascular treatments are safe in this group of patients. The ideal approach would be to mitigate the cardiovascular risk in HIV patients with specific primary prevention measures. All these issues are discussed in this review, which aims to aid clinical cardiologists faced with HIV patients with ischemic heart disease or with high cardiovascular risk in daily clinical practice.

Simultaneous subacute coronary drug-eluting stent thrombosis in two different vessels of a patient with factor V Leiden mutation

We review the case of a 46-year-old man who underwent elective percutaneous coronary intervention and stenting of the left anterior descending artery and right coronary artery with two sirolimus- and paclitaxel-eluting stents. Four days after angioplasty, he was readmitted with cardiogenic shock due to acute anterior and inferior myocardial infarction. Coronary angiography revealed subacute thrombosis of both stents, and balloon dilation was performed successfully thereafter. The follow-up investigations revealed that the patient was a carrier of factor V Leiden. We hereby discuss the importance of factor V Leiden as the most common cause of hypercoagulable state and its probable role in acute and subacute coronary stent thrombosis in drug-eluting stents.

Antiphospholipid antibodies in HIV-positive patients

Antiphospholipid (aPL) antibodies classically have been associated with thrombotic phenomena and abortion in patients with autoimmune diseases. The objective of the present work was to evaluate the frequency of such antibodies in patients infected with HIV and study its association with the presence of clinical manifestations of antiphospholipid syndrome (APS). Using a transversal study, a population of patients diagnosed with HIV, identified through an enzyme-linked immunosorbent assay (ELISA) test and confirmed by Western blotting, aged above 17 years old, was investigated. Through a standard questionnaire, the presence of APS manifestations was investigated, as well as the frequency of rheumatic manifestations. Antibodies against beta2 glycoprotein I (anti-beta2 GPI) and anticardiolipin (aCL) IgA, IgG, and IgM were investigated by the ELISA method using commercial kits (QUANTA Lite, INOVA Diagnostics). Ninety patients were studied, 47 (52.2%) male and 43 (47.8%) female. Clinical manifestations of APS were detected in 12 patients (13.3%) of the studied population, whereas arthralgia was the most common rheumatic manifestation (38.9%). Of the 90 patients, 40 (44.4%) were reactive for at least one type of aPL antibody (aCL and/or anti-beta2 GPI). The frequency of aCL was 17.8%, from which 15 (16.7%) had aCL IgG, 3 (3.3%) IgM, and 1 (1.1%) IgA. The frequency of the anti-beta2 GPI antibody was 33.3%, from which 29 (32.2%) were positive for isotype IgA, 4 (4.4%) isotype IgM, and 1 (1.1%) isotype IgG. No association was observed between immunoreactivity for aPL antibodies in general or each isotype in particular and the presence of APS manifestation. In the present study, it was possible to observe a relatively high frequency of aPL antibodies, particularly for isotype IgA anti-beta2 GPI in HIV. However, there was no association to APS manifestations, suggesting that such antibodies had no etiopathogenic role in these complications in patients with such retroviral infection.

[Risk factors in a young population with acute myocardial infarction: one year prospective study]

OBJECTIVE

The objective of this work is to give epidemiological data, established in a prospective way, on the myocardial infarction in young and its risk factors.

METHODS

All patients admitted to the CHG of Pau for myocardial infarction, old, for the men of less than 45 years and for the women of less than 55 years, of November the 1st 2002 to October 31st, 2003, are included.

RESULTS

Twenty-seven patients (11.2%) do a myocardial infarction including 44.4% women. The found traditional risk factors are: smoking (92.6%), absence of regular physical activity (81.5%), dyslipidaemia (66.7%), family history of cardiovascular disease (48.2%), hypertension (37.0%), obesity (18.5%), oral contraception (11.1%), diabetes (7.4%), personal thrombotic history (7.4%). The principal emergent risk factors highlighted are: stress (66.7%), inhibitor of the activation of the plasminogene (57.1%), C-reactive protein (50%), lipoprotein a (41.7%), fibrinogen (33.3%), elevated plasma homocysteine (25%), excessive alcohol use (22.2%). None patients does not have an absolute cardiovascular risk > 20%. The clinical characteristics, coronarographic data and the acute treatments were also listed. The prognosis is worse for the women with more risk factors, more complications, and risk of more significant ventricular replanning.

CONCLUSION

The principal risk factors of the myocardial infarction in young can be modifiable. The prevention is of primary importance. The therapeutic education of the patients corresponds to the total assumption of responsibility required by this pathology.