Updated cardiac concerns with rituximab use: A growing challenge

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Rituximab is increasingly used for oncological and immunological conditions.
• Thrombocytopenia is a known side effect, potentially increasing bleeding risk.
• Myocardial infarction (MI) is a rare but serious potential complication.

Purpose of the Study:

• To report a case of ST-elevation myocardial infarction (STEMI) during rituximab infusion.
• To discuss the management of MI in a patient with thrombocytopenia and high thrombus burden.
• To highlight the importance of considering MI as a complication of rituximab therapy.

Main Methods:

• A 62-year-old male with non-Hodgkin lymphoma (NHL) and thrombocytopenia received intravenous rituximab.
• Immediate coronary angiography revealed 100% occlusion of the right coronary artery (RCA).
• Successful primary percutaneous coronary intervention (PCI) with balloon angioplasty of the RCA was performed without stent placement.

Main Results:

• The patient developed acute STEMI 15 minutes after initiating rituximab infusion.
• Coronary intervention showed a high thrombus burden, treated with thrombosuction and balloon angioplasty.
• The patient was managed with dual antiplatelet therapy and regular platelet monitoring.

Conclusions:

• Myocardial infarction is a critical adverse event to consider during rituximab therapy, particularly in patients with pre-existing thrombocytopenia.
• Primary balloon angioplasty without stenting may be a suitable strategy for acute coronary occlusion in the context of high thrombus burden and thrombocytopenia.
• Awareness of this rare complication is crucial for clinicians managing patients on rituximab.