Bhisma Mohammad Satya, Pratanu Iswanto, Intan Ryan Enast, Alkaff Firas Farisi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Jl. Mayjend Prof. Dr. Moestopo No 4-6, Surabaya, East Java, 60286, Indonesia.
Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Jl. Mayjend Prof. Dr. Moestopo No 47, Surabaya, East Java, 60132, Indonesia.
Ann Med Surg (Lond). 2022 May 10;78:103730. doi: 10.1016/j.amsu.2022.103730. eCollection 2022 Jun.
and importance: Protein C and S deficiency are some of the coagulation cascade disorders which may also contributes not only to venous thromboembolism (VTE), but also rarely to arterial thrombosis. Here we present a report of 3 severe coronary artery disease (CAD) cases ranging from very young to elderly patients with concomitant inherited thrombophilia.
The first case was a chronic coronary syndrome from a very young male patient with history of VTE without any other risk factor of CAD. The second case was about premature CAD with triple chronic total occlusion (RCA, LCX, LAD) in patient under 45 years old, with single risk factor. The third case was about accelerated atherosclerosis progression from previously non significant stenosis in RCA into total occlusion in RCA and inferior STEMI in old patient on supposely adequate double anti platelet agent.
All patients had protein C and/or S deficiency and first degree family history of VTE, therefore inherited thrombophilia was diagnosed. We gave them oral anticoagulant in addition to their standard treatment for secondary prevention with good outcome and without further adverse event.
It is important to raise awareness to perform screening inherited thrombophilia as an important risk factor for CAD in special subgroup such as young age patient with rapid course progression and family history of VTE. The use of oral anticoagulants as either prophylactic or therapeutic purpose in patients with inherited thrombophilia are safe and effective. However, further research is still needed.
及其重要性：蛋白C和S缺乏是凝血级联紊乱的一部分，不仅可能导致静脉血栓栓塞（VTE），也很少会导致动脉血栓形成。在此，我们报告3例严重冠状动脉疾病（CAD）病例，患者年龄跨度从非常年轻到老年，均伴有遗传性易栓症。
第一例是一名非常年轻的男性慢性冠状动脉综合征患者，有VTE病史，无其他CAD危险因素。第二例是一名45岁以下的患者，患有早发性CAD伴三支慢性完全闭塞（右冠状动脉、左回旋支、左前降支），有单一危险因素。第三例是一名老年患者，其右冠状动脉先前无明显狭窄，在接受适当的双联抗血小板药物治疗时，右冠状动脉进展为完全闭塞并发生下壁ST段抬高型心肌梗死，提示动脉粥样硬化加速进展。
所有患者均有蛋白C和/或S缺乏以及VTE的一级家族史，因此诊断为遗传性易栓症。除了他们的二级预防标准治疗外，我们还给予他们口服抗凝剂，取得了良好的效果，且无进一步不良事件。
对于特殊亚组患者，如病程进展迅速且有VTE家族史的年轻患者，提高对遗传性易栓症筛查的认识非常重要，因为遗传性易栓症是CAD的重要危险因素。在遗传性易栓症患者中使用口服抗凝剂进行预防或治疗是安全有效的。然而，仍需要进一步研究。
