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Zheng Y, Xu T, Chen L, Lin S, Chen S. Percutaneous coronary intervention in patients with essential thrombocythemia: case reports and literature review. Platelets 2019; 31:815-819. [PMID: 31502506 DOI: 10.1080/09537104.2019.1665640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Essential thrombocythemia (ET) can cause systemic vascular thrombosis, but the involvement of coronary arteries is rare. This study is aimed to analyze the characteristics, treatment, and prognosis during follow-up in patients with ET after percutaneous coronary intervention (PCI). A total of eight patients with ET who had coronary heart disease and treated with PCI in our hospital from 2012 to 2018 were retrospectively studied. The basic clinical information with clinical data, data of coronary intervention, application of anti-platelet and platelet reducing drugs, and the results of long-term follow-up were recorded. There were five males and three females with a median age of 67 years. Clinical presentation was unstable angina in four cases, stable angina in one case, ST-elevation myocardial infarction in two cases, and non-ST elevation myocardial infarction in one case. The average platelet count was 722 × 109/L in admission, and hydroxyurea was used in seven cases. Coronary angiography suggested that all eight cases were single-vessel lesion. All the patients received PCI treatment, and Drug-eluting stent (DES) was used in all cases. Six were treated with one stent, one was treated with two stents and one was treated with three stents. After PCI, aspirin, and clopidogrel (or ticagrelor) were used in all cases. During the follow-up, one developed stent thrombus 2 months later, two developed stent restenosis 1 year later. In conclusion, PCI is an effective method of revascularization in patients with ET; but it may be associated with a higher rate of complications including stent thrombus and restenosis.
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Affiliation(s)
- Yaguo Zheng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University , Nanjing, Jiangsu, China
| | - Tian Xu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University , Nanjing, Jiangsu, China
| | - Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University , Nanjing, Jiangsu, China
| | - Song Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University , Nanjing, Jiangsu, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University , Nanjing, Jiangsu, China
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Shoji K, Yanishi K, Shiraishi J, Nakanishi N, Zen K, Nakamura T, Hyogo M, Shirayama T, Matoba S, Sawada T. In-stent Massive Thrombi Formation During Primary Percutaneous Coronary Intervention in a Patient with Acute Myocardial Infarction Complicated with Essential Thrombocythemia. Intern Med 2019; 58:1287-1293. [PMID: 30626836 PMCID: PMC6543226 DOI: 10.2169/internalmedicine.2083-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 61-year-old man with essential thrombocythemia (ET) presented with acute myocardial infarction (AMI) and underwent primary percutaneous coronary intervention. After stent deployment from the left main (LM) to the left anterior descending artery, intravascular ultrasound revealed thrombi formation in the whole stent. Two days later, optical frequency domain imaging confirmed stent malapposition and thrombi remaining in only the LM. The stent malapposition and ET might have contributed to this phenomenon. He underwent an additional stent expansion and aggressive anti-thrombotic regimen. AMI complicated with ET carries increased risks of in-stent thrombi formation and requires careful revascularization and aggressive pharmacotherapy.
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Affiliation(s)
- Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Jun Shiraishi
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Masayuki Hyogo
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Takahisa Sawada
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
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3
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Prinzmetal Angina in a Young Patient with Essential Thrombocythemia, After Anagrelide Initiation - Case Report and Literature Review. ARS MEDICA TOMITANA 2018. [DOI: 10.2478/arsm-2018-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
We report a case of Prinzmetal angina as inaugural manifestation of coronary disease, in a young adult male patient, recently started on anagrelide for essential thrombocythemia. Moderate proximal left anterior descendent coronary artery stenosis was documented by angiography, and interventional or surgical revascularization has been discussed. Patient’s option was for medical therapy alone. Anagrelide was temporarily withdrawn and rechallenged uneventfully after a couple of months and clinical evolution is good at four years follow-up. The mechanism by which anagrelide could induce coronary spasm and ischemia remains to be clarified.
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4
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Calreticulin Mutated Essential Thrombocythemia Presenting as Acute Coronary Syndrome. Case Rep Hematol 2015; 2015:161764. [PMID: 26064712 PMCID: PMC4429202 DOI: 10.1155/2015/161764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/12/2015] [Indexed: 11/18/2022] Open
Abstract
Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by a clonal expansion of megakaryocytes. ET can result in both arterial and venous thrombosis. Involvement of the coronary arteries has been reported. Patients who harbor a CALR mutation are half as likely to suffer a thrombotic event as compared to patients with a JAK2 mutation. We report a case of CALR-mutated ET whose initial disease manifestation was a non-ST segment elevation myocardial infarction.
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Bhat T, Ahmed M, Baydoun H, Ghandour Z, Bhat A, McCord D. Acute ST-segment elevation myocardial infarction in a young patient with essential thrombocythemia: a case with long-term follow-up report. J Blood Med 2014; 5:123-7. [PMID: 25093003 PMCID: PMC4114920 DOI: 10.2147/jbm.s53539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Essential thrombocythemia (ET) is a neoplastic proliferation of mature myeloid cells – in particular, megakaryocytes – leading to persistently elevated platelet count. Usual clinical presentation is related to an increase in the risk of hemorrhage and/or thrombosis. Management of ET consists of antiplatelet therapies – mainly aspirin and cytoreductive therapies. Coronary involvement in patients with ET is rare. The optimal treatment strategies for ET patients presenting with acute myocardial infarction remains unclear. Acute interventions like intracoronary thrombolytic therapy, angioplasty, and coronary-artery bypass grafting have been reported in such patients. However, several questions remain unanswered about the acute and long-term management of these patients. Herein, we report the case of a 47-year-old female who presented with acute myocardial infarction as the first clinical sign of ET, and also present the long-term follow-up of this patient.
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Affiliation(s)
- Tariq Bhat
- Division of Cardiology, Staten Island University Hospital, Staten Island, NY, USA
| | - Mohammed Ahmed
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Hassan Baydoun
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Zahraa Ghandour
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Alina Bhat
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Donald McCord
- Division of Cardiology, Staten Island University Hospital, Staten Island, NY, USA
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Singla A, Jagasia D, Garg M, Lowry PA, Stapleton D. Acute ST-segment elevation myocardial infarction: A rare initial presentation of previously undiagnosed essential thrombocythemia. Platelets 2012; 23:463-6. [DOI: 10.3109/09537104.2011.640966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee M, Lee C, Kim K, Kwon O, Choi H, Yoon D, Hong K. A Case of Recurrent Stent Thrombosis in a Patient with Essential Thrombocythemia. ACTA ACUST UNITED AC 2012. [DOI: 10.3904/kjm.2012.83.1.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mijin Lee
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Changseob Lee
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Kyunglee Kim
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Ohkyoung Kwon
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Hyunhee Choi
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Duckhyoung Yoon
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Kyungsoon Hong
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon, Korea
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Choi HS, Jeong MH, Seo IK, Lee MG, Ko JS, Park KH, Sim DS, Yoon NS, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Very Late Stent Thrombosis in a Drug-Eluting Stent due to Interruption of Anti-Platelet Agents in Patients With Acute Myocardial Infarction and Thrombocytosis. Korean Circ J 2011; 41:417-20. [PMID: 21860647 PMCID: PMC3152740 DOI: 10.4070/kcj.2011.41.7.417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 11/05/2010] [Accepted: 11/12/2010] [Indexed: 11/11/2022] Open
Abstract
Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy.
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Affiliation(s)
- Hong Sang Choi
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
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Bildirici U, Celikyurt U, Ural E. Essential thrombocythemia: a case of acute ST-segment elevation myocardial infarction in a young female. Clin Cardiol 2009; 32:104-5. [PMID: 19215011 DOI: 10.1002/clc.20426] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Essential thrombocythemia (ET) is a clonal disorder of the myeloid stem cell that causes abnormal proliferation of the megakaryocytes. The main feature of the disease is arterial and venous thrombosis caused by platelet dysfunction. Coronary artery involvement leading to acute coronary syndromes is a rare complication of the ET. We report a coronary angioplasty and stenting in a 30-year-old female patient with acute ST-segment elevation myocardial infarction (MI) as the first clinical sign of essential thrombocythemia. Facilitated percutaneous coronary intervention with GPIIb/IIIa and/or thrombolytic therapy may be considered as the first treatment modality for this patient group.
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Affiliation(s)
- Ulas Bildirici
- Department of Cardiology, Kocaeli University, 41380 Kocaeli, Turkey.
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Doesch C, Krämer B, Geisler T, May AE, Kroeber SM, Kandolf R, Gawaz M. Challenges in the treatment of patients with essential thrombocythemia and acute coronary syndrome. J Thromb Thrombolysis 2007; 25:193-7. [PMID: 17701105 DOI: 10.1007/s11239-007-0082-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Accepted: 07/24/2007] [Indexed: 11/25/2022]
Abstract
Essential thrombocythemia (ET) is an acquired clonal hematological stem-cell disorder that is characterized by a persistent increase in platelet count over 600,000/microl and elevated megakaryocyte levels in the bone marrow. Patients with ET are on the one hand at risk of thrombosis and on the other hand of hemorrhagic events especially in patients with very high platelet accounts. We report two illustrative cases with ET and acute coronary syndrome from our recent clinical experience illustrating the challenges in the antithrombotic treatment of these patients.
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Affiliation(s)
- Christina Doesch
- Department of Cardiology and Cardiovascular Disease, Otfried-Müller-Str. 10, Tuebingen, 72076, Germany.
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