Su Ho-Ming, Lee Kun-Tai, Chu Chin-Sheng, Sheu Sheng-Hsiung, Lai Wen-Ter
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2003 Apr;19(4):177-82. doi: 10.1016/S1607-551X(09)70468-1.
Antiphospholipid syndrome (APS) is an uncommon prothrombotic disorder that has been increasingly recognized in recent years. The diagnosis of APS must be associated with venous or arterial thrombosis or both. Patients with APS usually present with recurrent deep vein thrombosis, pulmonary thromboembolism, thromboembolic stroke, or myocardial infarction. Here, we report a case of a 61-year-old female who presented with a 3-month history of increasingly frequent retrosternal chest tightness. After treadmill test and thallium-201 myocardial perfusion scan, she was admitted and underwent elective coronary angiography but developed acute thrombosis after direct intracoronary stenting. She was successfully rescued with repeat percutaneous transluminal coronary angioplasty and prolonged heparin and glycoprotein IIb/IIIa antagonist use. Laboratory data showed prolongation of partial thromboplastin time and positive anti-cardiolipin antibody. These findings satisfied the criteria for APS; the patient was diagnosed with primary APS because she had neither typical symptoms nor signs of systemic lupus erythematosus or other immunologic disorders. Thereafter, long-term oral anticoagulant appeared to be effective. To our knowledge, this is the first report of acute stent thrombosis in a patient with primary APS.
抗磷脂综合征（APS）是一种近年来逐渐被认识的少见的血栓前状态疾病。APS的诊断必须与静脉或动脉血栓形成或两者均有关。APS患者通常表现为复发性深静脉血栓形成、肺血栓栓塞、血栓栓塞性卒中或心肌梗死。在此，我们报告一例61岁女性患者，她有3个月来胸骨后胸闷发作频率增加的病史。经运动平板试验和铊-201心肌灌注扫描后，她入院并接受了择期冠状动脉造影，但在直接冠状动脉内支架置入术后发生了急性血栓形成。通过重复经皮冠状动脉腔内血管成形术以及延长肝素和糖蛋白IIb/IIIa拮抗剂的使用，她成功获救。实验室检查数据显示部分凝血活酶时间延长以及抗心磷脂抗体阳性。这些发现符合APS的诊断标准；该患者被诊断为原发性APS，因为她既没有系统性红斑狼疮或其他免疫性疾病的典型症状也没有体征。此后，长期口服抗凝治疗似乎有效。据我们所知，这是原发性APS患者发生急性支架血栓形成的首例报告。
