Korean Circ J.  2012 Sep;42(9):646-649. 10.4070/kcj.2012.42.9.646.

Acute Stent Thrombosis and Heparin Induced Thrombocytopenia in a Patient With ST-Segment Elevation Myocardial Infarction

• Shin HW
• Yoon HJ
• Choi SW
• Bae HJ
• Sohn JH
• Lee HM
• Cho HO
• Cho YK
• Park HS
• Kim H
• Nam CW
• Hur SH
• Kim YN
• Kim KB

• KMID: 2297899
• DOI: http://doi.org/10.4070/kcj.2012.42.9.646

Abstract

Heparin is an essential drug in the treatment of acute coronary syndrome and it is used during percutaneous coronary intervention (PCI). Heparin-induced thrombocytopenia (HIT), albeit a serious complication of heparin therapy characterized by thrombocytopenia and high risk for venous and arterial thrombosis, has rarely been previously reported during PCI. We report a case of an acute stent thrombosis due to an unusual cause, HIT during primary PCI, in a patient with acute myocardial infarction.

Keyword

Heparin; Thrombocytopenia; Thrombosis; Myocardial infarction

MeSH Terms

Acute Coronary Syndrome
Heparin
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Stents
Thrombocytopenia
Thrombosis
Heparin

Figure

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  Fig. 1 Coronary angiogram demonstrated acute stent thrombosis during primary percutaneous coronary intervention. A: initial coronary angiogram revealed total occlusion of the mid portion of the right coronary artery (RCA) with thrombus. B: after stent deployment, thrombus (arrow) was shown at proximal portion of the stent. C: a few minutes after, it showed complete occlusion of the mid RCA stent site with progressed thormbus from the proximal portion of RCA.

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  Fig. 2 In intravascular ultrasound on right coronary artery after stent deployment, there was total occlusion by extensive thrombus and there was no evidence of edge dissection, incomplete stent apposition or underexpansion (arrow heads showed stent struts and arrow showed thrombus).

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  Fig. 3 Follow up coronary angiogram demonstrated persistent stent thrombosis. A: secondary stage coronary angiogram showed more progressed intracoronary thrombosis from RCA ostium. B: despite repeated balloon and thrombus aspiration Thrombolysis in Myocardial Infarction 3 flow could not be obtained. C: a few minute after, coronary flow of RCA was disappeared. RCA: right coronary artery.

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