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Simultaneous left anterior descending and right coronary stent thrombosis after aspirin withdrawal

Hesham R Omar1, Devanand Mangar, Rachel Karlnoski

  • 1Internal Medicine Department, Mercy Hospital and Medical Center, Chicago, IL, USA. hesham_omar2003@yahoo.com

The American Journal of Emergency Medicine
|March 6, 2012
PubMed

Insights

Discontinuing aspirin before surgery can lead to simultaneous stent thrombosis in two coronary arteries, a rare but serious complication. This case highlights the risks associated with drug-eluting stents and antiplatelet therapy withdrawal.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • ST-segment elevation myocardial infarction (STEMI) typically results from single-vessel coronary artery thrombosis.
  • Simultaneous thrombosis of two coronary arteries is rare and associated with poorer outcomes.
  • Postoperative myocardial infarction can occur due to surgical stress or other contributing factors.

Observation:

  • A case of simultaneous left anterior descending and right coronary artery stent thrombosis occurred postoperatively.
  • This event followed the cessation of long-term aspirin therapy in a patient with stable coronary artery disease.
  • The patient had undergone procedures involving drug-eluting stents.

Findings:

  • The postoperative simultaneous stent thrombosis involved two major coronary arteries.
  • Cessation of aspirin therapy was identified as a key factor preceding the thrombotic event.
  • Drug-eluting stents may have a higher risk of late stent thrombosis due to delayed endothelialization.

Implications:

  • Physicians must exercise extreme caution when considering the withdrawal of antiplatelet therapy before surgery.
  • This case underscores potential risks associated with drug-eluting stents and perioperative management.
  • Careful patient selection and management strategies are crucial to prevent rebound coronary thrombosis.

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