Zhao Ya-Nan, Chen Wei-Wei, Yan Xiao-Yu, Liu Kun, Liu Guo-Hui, Yang Ping
Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130000, Jilin Province, China.
Department of Cardiology, Jilin Provincial Cardiovascular Research Institute, Changchun 130000, Jilin Province, China.
World J Clin Cases. 2022 Nov 16;10(32):11955-11966. doi: 10.12998/wjcc.v10.i32.11955.
Aplastic anemia (AA) complicated with myocardial infarction (MI) is rare and associated with poor prognosis. Here, we present a case of AA with recurrent acute MI (AMI) in a patient treated with cyclosporine A (CsA) and stanozolol. In this patient, we suspect the long-term use of medication linked to platelets hyperfunction.
In 2017, a 45-year-old man was rushed to the emergency department of China-Japan Union Hospital due to precordial pain for 5 h. Based on his symptoms, medical history, blood tests, and findings from coronary angiography (CAG), the patient was diagnosed with acute anterior wall, ST-segment elevated MI, Killip II grade, AA, and dyslipidemia. In 2021, the patient was readmitted to the hospital for 2 h due to chest pain. Because the patient's platelet count was 30 × 10/L and he had severe thrombocytopenia, we performed CAG following platelet transfusion. Optical coherence tomography revealed lipid plaque and thrombus mass in his right coronary artery. The antithrombotic approach was adjusted to employ only anticoagulants (factor Xa inhibitors) and adenosine diphosphate inhibitors (clopidogrel) after assessing the risk of bleeding/thrombotic events. Long-term follow-up revealed that the patient had made a good recovery.
Patients with AA should be closely monitored for the risk of thrombosis and cardiovascular events, particularly when taking stanozolol or CsA for an extended period of time.
再生障碍性贫血（AA）合并心肌梗死（MI）较为罕见，且预后较差。在此，我们报告一例接受环孢素A（CsA）和司坦唑醇治疗的AA患者发生复发性急性心肌梗死（AMI）的病例。在该患者中，我们怀疑长期用药与血小板功能亢进有关。
2017年，一名45岁男性因心前区疼痛5小时被紧急送往中日联谊医院急诊科。根据其症状、病史、血液检查及冠状动脉造影（CAG）结果，该患者被诊断为急性前壁、ST段抬高型心肌梗死，Killip II级，AA，以及血脂异常。2021年，该患者因胸痛再次入院2小时。由于患者血小板计数为30×10/L且存在严重血小板减少症，我们在输注血小板后进行了CAG检查。光学相干断层扫描显示其右冠状动脉存在脂质斑块和血栓团块。在评估出血/血栓形成事件风险后，调整抗栓方案，仅使用抗凝剂（Xa因子抑制剂）和二磷酸腺苷抑制剂（氯吡格雷）。长期随访显示患者恢复良好。
AA患者应密切监测血栓形成和心血管事件风险，尤其是在长期服用司坦唑醇或CsA时。
