Essential thrombocytosis causing a massive myocardial infarction

What cardiologists should know about essential thrombocythemia and acute myocardial infarction: report of two cases and advanced heart failure therapies considerations

We present the cases of two young male patients aged 22 and 31 without prior medical history nor cardiovascular risk factors, who presented to the hospital with large anterior ST-elevation myocardial infarction (STEMI). Urgent coronary angiography revealed acute thrombotic occlusion of the proximal left anterior descending artery in both patients. Persistent thrombocytosis was noted and subsequent investigations led to the diagnosis of essential thrombocythemia (ET) with positive JAK2-V617F mutation. Myocardial infarction as a first clinical manifestation of ET is rare but must be considered in patients without cardiovascular risk factors who show persistent thrombocytosis. In young patients without risk factors, there may be great delays before the diagnosis of STEMI is made. Longer time to revascularization of extensive STEMI is associated with adverse outcomes and cardiogenic shock which can lead to advanced therapies like heart transplant and left ventricular assist device (LVAD). Considering the favorable long-term prognosis of patients with ET, advanced therapies may be a valuable option in the presence of severe left ventricular dysfunction.

Off-pump myocardial revascularization in a high-risk patient with essential thrombocythemia

Essential thrombocythemia is a rare type of myeloproliferative disorder. Cerebral, myocardial, and peripheral thrombosis are all frequent complications of the disease. A 71-year-old man presented with severe coronary artery disease, associated with cerebral vascular ischemic changes and erythromelalgia. His platelet count was 1,486 ×10(3)/μL. The patient underwent successful myocardial revascularization by means of an off-pump technique after his platelet count had been reduced by hydroxycarbamide administration. We conclude that the use of off-pump cardiopulmonary bypass in high-risk patients with essential thrombocythemia is safe. Reducing platelet count via the administration of hydroxycarbamide and the careful balancing of antiplatelets and anticoagulants is crucial in determining the outcome of surgery.

Off-pump coronary artery surgery in a patient with essential thrombocythaemia: two life-threatening complications in the same patient

Essential thrombocythaemia (ET) is a rare chronic myeloproliferative disease characterised by persistent thrombocytosis. Cerebral, myocardial and peripheral thrombosis are frequently seen complications, but bleeding and venous thrombosis are more rare. Here, a case of essential thrombocythaemia complicated by cerebral and myocardial thrombosis is presented. The patient's platelet count was 680×10(9)/litre on admission. Electrocardiogram showed a slight ST elevation in leads V1 to V4. A coronary angiography was performed and it revealed a severe stenosis of the left anterior descending artery. The patient had a successful off-pump coronary artery bypass grafting surgery. After the operation the platelet count was 390×10(9)/litre. The patient received hydroxyurea and aspirin treatment preoperatively and continued postoperatively. ET is a rare myeloproliferative disease; its complications are also rare, but the occurrence of two life-threatening complications in the same patient is rarer still. Further investigations are needed to determine the risk stratification for patients with ET undergoing cardiac surgery.

Essential thrombocytemia and acute coronary syndrome: clinical profile and association with other thromboembolic events

BACKGROUND

The existence of a relationship between essential thrombocytemia (ET) and acute coronary syndromes (ACS) has been suggested.

METHOD

Data from eleven consecutive patients admitted with ET in the cardiology department were reviewed.

RESULTS

Nine patients (82%) presented with ACS and two with bradycardia. Patients with ACS had a mean age of 67+/-11 years. Risk factors, especially hypertension (6, 66.7%), and smoking (6, 66.7%) were frequent. Average platelet count was 509 778+/-282 126/mm3. Significant coronary lesions were found in five of six patients studied with coronary angiography. During hospitalization, a patient suffered a thrombotic stroke, a massive pulmonary embolism, and partial aortic thrombosis. Another patient had a transient ischemic attack. Discharge treatments were aspirin (78%), clopidogrel (56%), acenocumarol (33%), hydroxyurea (56%) and anagrelide (44%). Three patients (27%) had thromboembolic events during follow-up (median 1.6 years), 2 patients had coronary events and 1 patient had venous thrombosis. There were neither significant haemorrhages nor deaths.

CONCLUSIONS

Patients with ET and ACS have similar profiles to those of traditional ACS with frequent risk factors and significant coronary artery disease. Association with other thrombotic events can be seen during admission and follow-up while haemorrhagic complications seem to be rare.