Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3936
Peer-review started: October 17, 2021
First decision: January 11, 2022
Revised: January 19, 2022
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Processing time: 185 Days and 20.5 Hours
There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia (CAE).
This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction (AMI). The first antithrombotic agents used were aspirin (100 mg/d) and clopidogrel (75 mg/d). During the sixth month of observation, a second AMI occurred involving the same culprit vessel; therefore, antithrombotic agents were changed to aspirin (100 mg/d) and ticagrelor (90 mg twice per day). Twelve months after the second AMI, an attempt to reduce the dosage ticagrelor failed; therefore the original dose was continued. The CAE was relatively stable during the following 4 years.
This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.
Core Tip: Here we present an antithrombotic strategy for patients with coronary artery ectasia as follows: (1) For patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) is recommended with the combination of aspirin and ticagrelor; further, more aggressive treatment combining DAPT with an anti-coagulant agent should be considered for patients with a high risk of thrombosis; and (2) ACS patients after 12 mo or patients without ACS should be routinely placed on aspirin as primary prevention, and DAPT would be a better choice if the patient does not have a high risk of bleeding.