Left main coronary artery thrombus resulting from combined protein C and S deficiency

Area of Science:

• Cardiovascular Medicine
• Hematology
• Genetics

Background:

• Inherited hypercoagulopathies, including protein C and S deficiencies, are typically associated with venous thromboembolism.
• Arterial thrombosis is an uncommon manifestation of these inherited conditions.
• Previous reports suggest a link between protein C/S deficiency and myocardial infarction, but not specifically coronary artery thrombi.

Observation:

• A young patient with diagnosed protein C and S deficiency presented with a left main coronary artery thrombus.
• The patient had no prior history of thrombosis or cardiovascular events.
• Coronary angiography revealed a thrombus in the left main coronary artery with otherwise normal coronary arteries.

Findings:

• This case represents the first reported instance of a left main coronary artery thrombus attributed to protein C and S deficiency.
• The findings underscore the potential for severe arterial thrombotic events in individuals with these specific inherited hypercoagulopathies.
• The absence of traditional risk factors in the patient emphasizes the role of the underlying genetic predisposition.

Implications:

• Highlights the importance of considering inherited thrombophilias in young patients presenting with arterial thrombosis, even in unusual locations like the left main coronary artery.
• Suggests that protein C and S deficiencies may pose a greater risk for coronary artery thrombosis than previously recognized.
• Warrants further investigation into the mechanisms linking protein C and S deficiencies to specific arterial territories and the potential for targeted prophylactic strategies.