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CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1532842
This article is part of the Research Topic Case Reports in Coronary Artery Disease: 2024 View all 12 articles
Short-term recurrent coronary artery thrombosis with acute myocardial infarction in a patient with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome: A case report
Provisionally accepted- Department of Cardiology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
Background: Acute myocardial infarction commonly occurs in patients with coronary artery disease, but rarely, it can develop under a hypercoagulable state.Aplastic anemia can be accompanied by paroxysmal nocturnal hemoglobinuria clones or transform into paroxysmal nocturnal hemoglobinuria with a significantly elevated prothrombotic state. These thrombotic complications predominantly arise in veins rather than in arteries. Coronary artery thrombosis in these patients, especially with short-term recurrent arterial thrombosis after initial successful treatment, is exceedingly rare.Presentation: A 39-year-old man with a history of aplastic anemia with paroxysmal nocturnal hemoglobinuria clones for 8 years presented with chest pain, and was diagnosed with acute inferior wall myocardial infarction on November 21, 2022. Despite standardized coronary intervention and anticoagulant/antiplatelet therapy, the patient reported intermittent chest discomfort with persistently elevated cardiac troponin and D-dimer levels 20 days after initial treatment. Repeat coronary angiography confirmed recurrent thrombosis in the right coronary artery. He underwent repeated balloon dilation and thrombus aspiration with intensified anticoagulation, which alleviated his clinical symptoms and normalized his cardiac troponin and D-dimer levels. The patient was finally confirmed to have aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome. Conclusion: Patients with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome can have thrombosis in arteries, such as coronary arteries, leading to acute myocardial infarction. Recurrent coronary artery thrombosis can occur after initial successful revascularization and anticoagulant/antiplatelet therapy. Close monitoring of clinical symptoms, repeated electrocardiogram and laboratory tests, coronary 3 angiography, strengthened anticoagulation, and precautions for bleeding risks should be considered in patients with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome.
Keywords: aplastic anemia, Paroxysmal nocturnal hemoglobinuria, acute myocardial infarction, cardiac troponin, Myocardial injury, Coronary Thrombosis
Received: 22 Nov 2024; Accepted: 03 Mar 2025.
Copyright: © 2025 Fu, Guo, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wen-Quan Zhang, Department of Cardiology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
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