ST-Segment Elevation Myocardial Infarction and Bleeding Complications in JAK2-Negative Polycythemia

Area of Science:

• Hematology
• Cardiology
• Genetics

Background:

• Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by increased red blood cell production.
• Patients with PV have a hypercoagulable state, increasing risks of thrombotic events and hemorrhage.
• Genetic mutations, particularly in the JAK2 gene, are common in PV, but JAK2 V617F-negative cases exist.

Observation:

• This case report details a Hispanic patient with JAK2 V617F-negative primary polycythemia.
• The patient presented with cardiac arrest and ST-segment elevation myocardial infarction (STEMI) due to left anterior descending artery occlusion.
• The patient also experienced significant bleeding complications and developed postmyocardial pericarditis.

Findings:

• Management of acute myocardial infarction in polycythemia vera presents unique challenges due to the dual risk of thrombosis and bleeding.
• This JAK2 V617F-negative case illustrates the complex clinical course, including cardiac arrest and hemorrhagic complications.
• The development of postmyocardial pericarditis adds to the patient's clinical burden.

Implications:

• Physicians must carefully balance anticoagulation and antiplatelet therapies in PV patients experiencing acute coronary syndromes.
• Understanding the specific risks in JAK2 V617F-negative PV is crucial for tailored treatment strategies.
• This case underscores the need for vigilant monitoring and management of both thrombotic and bleeding risks in polycythemia vera.