Case Report: Free-Floating Intracoronary Thrombus: Who Is the Convict?

Area of Science:

• Cardiology
• Hematology
• Oncology

Background:

• Acute coronary syndromes (ACS) in young patients often lack traditional cardiovascular risk factors.
• Hypercoagulable states represent an underrecognized cause of ACS in this demographic.
• Myeloproliferative neoplasms (MPNs) are a group of disorders characterized by the overproduction of blood cells, increasing thrombotic risk.

Observation:

• A 49-year-old woman presented with acute myocardial infarction (MI) despite the absence of conventional coronary artery disease risk factors.
• Diagnostic workup revealed an underlying myeloproliferative neoplasm.

Findings:

• The diagnosis of MPN in a patient with ACS highlights the importance of considering thrombophilia in unexplained cardiac events.
• MPNs present a dual risk of thrombosis and bleeding, complicating treatment decisions.
• Long-term management, particularly dual antiplatelet therapy (DAPT), requires careful balancing of risks and may necessitate frequent adjustments based on bleeding complications.

Implications:

• This case underscores the need for a comprehensive etiological investigation in young ACS patients, including screening for hypercoagulable states and MPNs.
• Clinical decision-making for antithrombotic therapy in MPN patients with ACS must be individualized, considering both thrombotic and hemorrhagic risks.
• Further research into optimal antithrombotic strategies for MPN patients experiencing ACS is warranted to improve patient outcomes.