Skip to main content
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;21(2):134–138. doi: 10.1002/clc.4960210218

Multivessel coronary thrombosis treated with abciximab (reopro®) in a patient with essential thrombocythemia

Andrew D Michaels 1, Brian Whisenant 1, John S Macgregor 2,
PMCID: PMC6656268  PMID: 9491958

Abstract

A 50‐year‐old man was admitted with acute inferior and anterior myocardial infarction. The patient was diagnosed with essential thrombocythemia (ET) based on the findings of marked thrombocytosis of 1,113 × 103/mm3, splenomegaly, and numerous clumping megakaryocytes on bone marrow biopsy. Emergent coronary angiography revealed extensive multivessel thrombosis involving the left main coronary artery and completely occluding the proximal right coronary artery. In addition to standard therapy with aspirin, heparin, and primary angioplasty of the right coronary artery, the patient received additional antiplatelet therapy with ticlopidine, hydroxyurea, and the platelet glycoprotein IIb/IIIa receptor‐inhibiting monoclonal antibody drug abciximab (ReoPro®). Serial coronary angiograms 1 and 5 days following the infarction showed progressive thrombus resolution. The pathophysiologic mechanisms and therapeutic challenges of ET‐associated coronary thrombosis are discussed in this report.

Keywords: acute myocardial infarction, essential thrombocythemia, thrombocytosis, multivessel coronary thrombosis, primary angioplasty, abciximab, ReoPro®

Full Text

The Full Text of this article is available as a PDF (1.0 MB).

References

  • 1. Fialkow PJ, Faguet GB, Jacobson RJ, Vaidya K, Murphy S: Evidence that essential thrombocythemia is a clonal disorder with origin in a multipotent stem cell. Blood 1981; 58: 916–919 [PubMed] [Google Scholar]
  • 2. Mitus AJ, Barbui T, Shulman LN, Rosenthal DS, Viero P, Cortelazzo S, Schafer AI: Hemostatic complications in young patients with essential thrombocythemia. Am J Med 1990; 88: 371–375 [DOI] [PubMed] [Google Scholar]
  • 3. Murphy MF, Clarke CR, Brearley BL: Superior sagittal sinus thrombosis and essential thrombocythaemia. Br Med J 1983; 287: 1344 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Walther EU, Tiecks FP, Haberl RL: Cranial sinus thrombosis associated with essential thrombocythemia followed by heparin‐associated thrombocytopenia. Neurology 1996; 47: 300–301 [DOI] [PubMed] [Google Scholar]
  • 5. Falconer J, Pineo G, Blahey W, Bowen T, Docksteader B, Jadusingh I: Essential thrombocythemia associated with recurrent abortions and fetal growth retardation. Am J Hematol 1987: 25: 345–347 [DOI] [PubMed] [Google Scholar]
  • 6. Mercer B, Drouin J, Jolly E, d'Anjou G: Primary thrombocythemia in pregnancy: A report of two cases. Am J Obstet Gynecol 1988; 159: 127–128 [DOI] [PubMed] [Google Scholar]
  • 7. Davis RB: Acute thrombotic complications of myeloproliferative disorders in young adults. Am J Clin Pathol 1985; 84: 180–185 [DOI] [PubMed] [Google Scholar]
  • 8. McIntyre KJ, Hoagland HC, Silverstein MN, Petitt RM. Essential thrombocythemia in young adults. Mayo Clin Proc 1991; 66: 149–154 [DOI] [PubMed] [Google Scholar]
  • 9. Randi ML, Fabris F, Tison T, Barbone E, Rossi C, Giralami A: Prevalence of specific thrombotic accidents in patients with throm‐bocytosis. Haematology 1993; 25: 149–152 [PubMed] [Google Scholar]
  • 10. Johnson M, Gernsheimer T, Johansen K: Essential thrombocytosis: Underemphasized cause of large‐vessel thrombosis. J Vasc Surg 1995; 22: 443–447 [DOI] [PubMed] [Google Scholar]
  • 11. Spach MS, Howell DA, Harris JS: Myocardial infarction and multiple thrombosis in a child with primary thrombocytosis. Pediatrics 1963; 31: 268–276 [PubMed] [Google Scholar]
  • 12. Virmani R, Popovsky MA, Roberts WC: Thrombocytosis, coronary thrombosis and acute myocardial infarction. Am J Med 1979; 67: 498–506 [DOI] [PubMed] [Google Scholar]
  • 13. Okayasu N, Murata M, Ueda A, Su KM, Sada T, Ito T, Hasegawa Y, Matsumoto S, Ito Y: Primary thrombocythemia and myocardial infarction in a 26‐year‐old woman with normal coronary angiogram. Jpn Heart J 1981; 22: 439–445 [DOI] [PubMed] [Google Scholar]
  • 14. Saffitz JE, Phillips ER, Temesy‐Armos PN, Roberts WC: Thrombocytosis and fatal coronary heart disease. Am J Cardiol 1983; 52: 651–652 [DOI] [PubMed] [Google Scholar]
  • 15. Takahashi H, Koeda T, Usui Y, Nakai K, Doijiri K, Honma H, Ichikawa T, Kato M: A case of essential hemorrhagic thrombo‐cythemia associated with subendocardial infarction and acute renal failure. J Jpn Intern Med 1983; 72: 569–575 (in Japanese) [PubMed] [Google Scholar]
  • 16. Dousle‐Blazy P, Taudou MJ, Delay M, Pris J, Sie P, Ribaut L, Galinier F, Bernadet P: Essential thrombocythaemia and recurrent myocardial infarction (letter). Lancet 1984; 27: 992 [DOI] [PubMed] [Google Scholar]
  • 17. Yano K, Takeyama HJ, Watanabe E, Kataoka T, Statke T: A case of essential thrombocythemia associated with myocardial and cerebral infarction. Naika 1986; 57: 177–179 (in Japanese) [Google Scholar]
  • 18. Ushiyama K, Aoki Y, Ninomiya H, Nagasawa T, Abe T, Yanagisawa G: A case of essential thrombocythemia with acute myocardial infarction. Naika 1987; 60: 1399–1402 (in Japanese) [Google Scholar]
  • 19. Louwerenburg JW, Suttorp MJ, Kingma JH: Aspirin withdrawal in a patient with essential thrombocythemia: Possible cause of myocardial infarction (letter). Am J Med 1987; 83: 1175 [DOI] [PubMed] [Google Scholar]
  • 20. Suzuki A, Suzuki F, Takahata H, Igarashi K, Hirosaka A, Takezawa M, Kimura H, Kariyone S: Essential thrombocythemia associated with myocardial infarction‐a case report. Shinzo 1988; 20: 444–450 (in Japanese) [Google Scholar]
  • 21. Hamada Y, Matsuda Y, Fujii B, Ohno H, Takashiba K, Ebihara H, Hyakuna E: Multiple coronary thrombosis in a patient with throm‐bocytosis. Clin Cardiol 1989; 12: 723–724 [DOI] [PubMed] [Google Scholar]
  • 22. Furui J, Yamada Y, Tsuzuki M, Yamauchi K, Hayashi H, Saito H, Hasegawa S: A case of essential thrombocythemia associated with acute myocardial infarction. Shinzo 1990; 22: 180–184 (in Japanese) [Google Scholar]
  • 23. Pick RA, Glover MU, Nanfro JJ, Dubbs WF, Gibbons JA, Vieweg WVR: Acute myocardial infarction with essential thrombocythemia in a young man. Am Heart J 1983; 106: 406–407 [DOI] [PubMed] [Google Scholar]
  • 24. Momiyama T, Hiranaka T, Nomura F, Tominaga H, Nishioka T: Coronary artery bypass grafting for left main trunk coronary artery lesion associated with essential thrombocythemia. Clin Cardiol 1993; 16: 691–693 [DOI] [PubMed] [Google Scholar]
  • 25. Kwaan HC, Suwanwela N: Inhibitors of fibrinolysis in platelets in polycythaemia vera and thrombocytosis. Br J Haematol 1971; 21: 313–322 [DOI] [PubMed] [Google Scholar]
  • 26. Wieczorek I, MacGregor IR, Ludlam CA: Low proteins C and S and activation of fibrinolysis in treated essential thrombocythemia. Am J Hematol 1995; 49: 277–281 [DOI] [PubMed] [Google Scholar]
  • 27. Walsh PN, Murphy S, Barry WE: The role of platelets in the pathogenesis of thrombosis and hemorrhage in patients with thrombocytosis. Thromb Haemost 1977; 38: 1085–1096 [PubMed] [Google Scholar]
  • 28. Wanstrup J, Kjeldsen K, Astrup P: Acceleration of spontaneous intimal‐subintimal changes in rabbit aorta by a prolonged moderate carbon monoxide exposure. Acta Pathol Microbiol Scand 1969; 75: 353–362 [PubMed] [Google Scholar]
  • 29. Davis RB, Leuschen MP, Boyd D, Goodlin RC: Evaluation of platelet function in pregnancy: Comparative studies in non‐smokers and smokers. Thromb Res 1987; 46: 175–186 [DOI] [PubMed] [Google Scholar]
  • 30. Fuchs J, Weinberger I, Rotenberg Z, Erdberg A, Davidson E, Joshua H, Agmon J: Plasma viscosity in ischemic heart disease. Am Heart J 1984; 108: 435–439 [DOI] [PubMed] [Google Scholar]
  • 31. EPIC Investigators : Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high‐risk coronary angioplasty. N Engl J Med 1994; 330: 956–961 [DOI] [PubMed] [Google Scholar]
  • 32. Lefkovits J, Plow EF, Topol EJ: Platelet glycoprotein IIb/IIIa receptors in cardiovascular medicine. N Engl J Med 1995; 332: 1553–1559 [DOI] [PubMed] [Google Scholar]
  • 33. Tefferi A, Hoagland HC: Issues in the diagnosis and treatment of essential thrombocytosis. Mayo Clin Proc 1994; 69: 651–655 [DOI] [PubMed] [Google Scholar]
  • 34. Cortelazzo S, Finazzi G, Ruggari 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; 332: 1132–1136 [DOI] [PubMed] [Google Scholar]
  • 35. Kleiman NS, Raizner AE, Jordan R, Wang AL, Norton D, Mace KF, Joshi A, Coller BS, Weisman HF: Differential inhibition of platelet aggregation induced by adenosine diphosphate or a thrombin receptor‐activating peptide in patients treated with bolus chimeric 7E3 Fab: Implications for inhibition of the internal pool of GPIIb/IIIa receptors. J Am Coll Cardiol 1995; 26: 1665–1671 [DOI] [PubMed] [Google Scholar]
  • 36. Tcheng JE, Ellis SG, George BS, Kereiakes DJ, Kleiman NS, Talley JD, Wang AL, Weisman HF, Califf RM, Topol EJ: Pharma‐codynamics of chimeric glycoprotein IIb/IIIa integrin antiplatelet antibody 7E3 in high‐risk coronary angioplasty. Circulation 1994; 90: 1757–1764 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES