Acute and Subacute Stent Thrombosis in a Patient With Clopidogrel Resistance: A Case Report

The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea.
Korean Circulation Journal (Impact Factor: 0.75). 10/2009; 39(10):434-8. DOI: 10.4070/kcj.2009.39.10.434
Source: PubMed


Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.

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    • "Some cases on consecutive events of acute MI were also reported. The reasons of consecutive acute MI are clopidogrel resistance,11) anatomical abnormality (papillary fibroelastoma12)), hematologic abnormality (antithrombin III deficiency13)), or other specific underlying diseases. One case was reported with two consecutive events of acute MI in two different vessels during a four-year interval. "
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    ABSTRACT: A 51-year-old man was being admitted to the emergency department with chest pains. He had a history of acute myocardial infarction (MI) on two prior occasions and was successfully treated with drug eluting stents. He was diagnosed with 3 consecutive events of acute MI in 3 different vessels. The consecutive events of acute MI in different vessels are a very rare case. He did not have risk factors, such as coagulation abnormality, clopidogrel resistance, patient's compliance and vessel abnormality, except for his cigarette smoking. We reported the first case with 3 consecutive events of acute MI in each 3 vessels during a long-term interval.
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    • "However the heparin platelet factor 4 antibodies were 0.419 OD (mildly abnormal) which were not consistent with a diagnosis of HIT [9]. Clopidogrel and aspirin resistance have been shown to be associated with stent thrombosis [10] [11]. Our patient suffered from very early stent thrombosis despite therapy with antiplatelet agents (aspirin, clopidogrel, and eptifibitide). "
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