Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11955
Peer-review started: July 13, 2022
First decision: September 25, 2022
Revised: October 1, 2022
Accepted: October 18, 2022
Article in press: October 18, 2022
Published online: November 16, 2022
Processing time: 117 Days and 18.9 Hours
Aplastic anemia (AA) complicated with myocardial infarction (MI) is rare and associated with poor prognosis. Here, we present a case of AA with recurrent acute MI (AMI) in a patient treated with cyclosporine A (CsA) and stanozolol. In this patient, we suspect the long-term use of medication linked to platelets hyperfunction.
In 2017, a 45-year-old man was rushed to the emergency department of China-Japan Union Hospital due to precordial pain for 5 h. Based on his symptoms, medical history, blood tests, and findings from coronary angiography (CAG), the patient was diagnosed with acute anterior wall, ST-segment elevated MI, Killip II grade, AA, and dyslipidemia. In 2021, the patient was readmitted to the hospital for 2 h due to chest pain. Because the patient’s platelet count was 30 × 109/L and he had severe thrombocytopenia, we performed CAG following platelet transfusion. Optical coherence tomography revealed lipid plaque and thrombus mass in his right coronary artery. The antithrombotic approach was adjusted to employ only anticoagulants (factor Xa inhibitors) and adenosine diphosphate inhibitors (clopidogrel) after assessing the risk of bleeding/thrombotic events. Long-term follow-up revealed that the patient had made a good recovery.
Patients with AA should be closely monitored for the risk of thrombosis and cardiovascular events, particularly when taking stanozolol or CsA for an extended period of time.
Core Tip: Acute myocardial infarction combined with aplastic anemia (AA) has been reported but not well studied. The medicine used to treat AA in this patient may have caused coronary artery and left ventricular thrombosis. Coronary intervention, particularly stenting, is still controversial in this rare clinical scenario. Thus far, no specific management regarding this disease, especially for intracoronary findings, has been reported. Early revascularization may be the most important factor in improving patient prognosis.