Recurrent cardiac drug-eluting stent thrombosis due to antiphospholipid syndrome: a case report.

Background: Antiphospholipid syndrome (APS) is an immune-mediated thrombo-inflammatory disease that causes arterial and venous thromboembolic events. The European Society of Cardiology (ESC) recommends treating APS with warfarin, covering with low molecular weight heparin until the international normalized ratio (INR) is therapeutic. The aim of this case report was to bring attention of increased risk of acute thrombotic episodes in patients with APS. Case Description: We describe the case of a 69-year-old man with APS who developed recurrent stent thrombosis with subsequent myocardial injury, which led to acute heart failure. A failure to adequately anticoagulated might be contributed to recurrent thrombosis. In retrospect review of the case, one of the predisposing factors could be when the patient was sub-therapeutic INR, appropriate bridging with low molecular heparin was not given. The treatment goal was best medical management for heart failure, cardiac rehabilitation, and maintaining a therapeutic INR for APS. In the long-term follow-up of this patient, he did not develop further thrombotic episodes after discharge from the hospital. Conclusions: In APS, there is an increased risk of thrombosis episodes in addition to pre-existing patient factors. Major thrombotic episodes are at risk, and these risks need to be stratified according to individual patient factors. Early involvement of multidisciplinary team and adequate anticoagulation could have prevented acute recurrent stent thrombosis.