Skip to main content
NCBI home page
Heart logoLink to Heart
. 2000 Jun;83(6):e10. doi: 10.1136/heart.83.6.e10

Multivessel coronary thrombosis, acute myocardial infarction, and no reflow in a patient with essential thrombocythaemia

H Terada, H Satoh, A Uehara
PMCID: PMC1760868  PMID: 10814644

Abstract

Essential thrombocythaemia (ET) has been reported rarely to cause coronary thrombosis, but the management is still undefined. A 63 year old woman with multivessel coronary thrombosis, acute myocardial infarction (MI), and no reflow in reperfused coronary artery in association with ET is presented. The patient's platelet count was only moderately raised at the onset of MI, but peripheral blood smear and bone marrow evaluation revealed clumping giant platelets and numerous large hyperploid megakaryocytes. Long term prophylaxis with antiplatelet agents in patients with ET is recommended, even if the platelet count is not largely raised. Cytoreductive treatment may also be effective for secondary prevention when thrombotic complications occur.


Keywords: essential thrombocythaemia; thrombosis; coronary artery; no reflow

Full Text

The Full Text of this article is available as a PDF (100.4 KB).

Figure 1  .

Figure 1  

Open in a new tab

(A) and (B): Emergent angiography of right coronary artery (RCA) and left coronary artery (LCA). Arrows indicate thrombus-like filling defect with a hazy appearance in the proximal portion of RCA and completely occluded left descending artery (LAD). (C): LCA angiography after angioplasty. Though the occluded lesion was successfully dilated, the perfusion delay in LAD remained (no reflow: arrow). (D) and (E): Repeat angiography one month after infarction. There were no thrombus-like filling defects or significant athelosclerotic lesions in the coronary arteries, and the coronary flow in LAD was not slow.

Figure 2  .

Figure 2  

Open in a new tab

Time course of blood platelet counts in the patient. AMI indicates the onset of acute myocardial infarction. The shaded area shows the normal range of the platelet count in our institute.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cortelazzo S., Finazzi G., Ruggeri M., Vestri O., Galli M., Rodeghiero F., Barbui T. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995 Apr 27;332(17):1132–1136. doi: 10.1056/NEJM199504273321704. [DOI] [PubMed] [Google Scholar]
  2. Fagher B., Sjögren A., Sjögren U. Platelet counts in myocardial infarction, angina pectoris and peripheral artery disease. Acta Med Scand. 1985;217(1):21–26. doi: 10.1111/j.0954-6820.1985.tb01629.x. [DOI] [PubMed] [Google Scholar]
  3. Ishihara M., Sato H., Tateishi H., Kawagoe T., Shimatani Y., Kurisu S., Sakai K. Attenuation of the no-reflow phenomenon after coronary angioplasty for acute myocardial infarction with intracoronary papaverine. Am Heart J. 1996 Nov;132(5):959–963. doi: 10.1016/s0002-8703(96)90005-8. [DOI] [PubMed] [Google Scholar]
  4. Koh K. K., Cho S. K., Kim S. S., Oh B. H., Lee Y. W. Coronary vasospasm, multiple coronary thrombosis, unstable angina and essential thrombocytosis. Int J Cardiol. 1993 Sep;41(2):168–170. doi: 10.1016/0167-5273(93)90158-d. [DOI] [PubMed] [Google Scholar]
  5. Martin J. F., Trowbridge E. A., Salmon G., Plumb J. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res. 1983 Dec 1;32(5):443–460. doi: 10.1016/0049-3848(83)90255-4. [DOI] [PubMed] [Google Scholar]
  6. Michaels A. D., Whisenant B., MacGregor J. S. Multivessel coronary thrombosis treated with abciximab (ReoPro) in a patient with essential thrombocythemia. Clin Cardiol. 1998 Feb;21(2):134–138. doi: 10.1002/clc.4960210218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Randi M. L., Fabris F., Stocco F., Tison T., Girolami A. Multiple, relapsing thrombosis in a young man with primary thrombocytosis. Blood Coagul Fibrinolysis. 1990 Aug;1(3):331–332. doi: 10.1097/00001721-199008000-00011. [DOI] [PubMed] [Google Scholar]
  8. Rossi C., Randi M. L., Zerbinati P., Rinaldi V., Girolami A. Acute coronary disease in essential thrombocythemia and polycythemia vera. J Intern Med. 1998 Jul;244(1):49–53. doi: 10.1046/j.1365-2796.1998.00314.x. [DOI] [PubMed] [Google Scholar]
  9. Tai Y. T., Yu Y. L., Lau C. P., Fong P. C. Myocardial infarction complicating postsplenectomy thrombocytosis, with early left ventricular mural thrombus formation and cerebral embolism--a case report. Angiology. 1993 Jan;44(1):73–77. doi: 10.1177/000331979304400112. [DOI] [PubMed] [Google Scholar]
  10. Virmani R., Popovsky M. A., Roberts W. C. Thrombocytosis, coronary thrombosis and acute myocardial infarction. Am J Med. 1979 Sep;67(3):498–506. doi: 10.1016/0002-9343(79)90800-3. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES