Nanas John N, Gougoulakis Alekos, Kanakakis John
University of Athens School of Medicine, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
Can J Cardiol. 2003 Aug;19(9):1063-5.
Following pretreatment with ticlopidine 250 mg bid for three days, a 40-year-old man underwent successful angioplasty and stenting of the proximal left anterior descending coronary artery and balloon dilation of the midcircumflex coronary artery without stenting. He subsequently developed acute coronary thromboses at both arterial sites and cardiogenic shock. The patient survived after an additional percutaneous coronary intervention (PCI) and intra-aortic balloon pump assistance. This was followed by peripheral arterial thrombosis requiring repeated therapeutic interventions. Laboratory tests for thrombophilia revealed the presence of a G20210A prothrombin gene mutation. Two years later the patient remained free of angina and claudication, and underwent an unremarkable maximum exercise treadmill test. This is the first reported case of acute, multiple coronary and peripheral arterial thrombosis following PCI in a patient with previously unsuspected inherited thrombophilia. Inherited thrombophilia should be considered as a possible cause of arterial thrombosis following PCI.
在接受噻氯匹定250毫克每日两次预处理三天后，一名40岁男性成功接受了左前降支冠状动脉近端的血管成形术和支架置入术，以及左旋支冠状动脉中段的球囊扩张术（未置入支架）。随后，他在两个动脉部位均出现急性冠状动脉血栓形成，并发生心源性休克。在接受了额外的经皮冠状动脉介入治疗（PCI）和主动脉内球囊泵辅助治疗后，患者存活下来。随后出现外周动脉血栓形成，需要反复进行治疗干预。血栓形成倾向的实验室检查显示存在G20210A凝血酶原基因突变。两年后，患者未出现心绞痛和跛行症状，并进行了一次正常的最大运动平板试验。这是首次报道的在PCI后发生急性、多发性冠状动脉和外周动脉血栓形成的病例，该患者之前未被怀疑患有遗传性血栓形成倾向。遗传性血栓形成倾向应被视为PCI后动脉血栓形成的可能原因。
