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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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ST-Elevation Myocardial Infarction Despite Adequate Anticoagulation in a Patient With Triple-Positive

Kajananan Sivagurunathan1, Nishadi Perera1, Anuranga Senanayake1

  • 1Internal Medicine, District General Hospital, Kilinochchi, LKA.

Cureus
|August 7, 2025
PubMed

Antiphospholipid syndrome is a prothrombotic autoimmune disorder that can lead to arterial thrombotic events such as acute myocardial infarction. We report a case of a 40-year-old female with triple-positive antiphospholipid syndrome on therapeutic warfarin who presented with anterior ST-elevation myocardial infarction. With an international normalized ratio of 2.3, thrombolysis was contraindicated, and primary percutaneous coronary intervention was unavailable due to resource limitations. She was managed conservatively with enoxaparin, dual antiplatelet therapy, and supportive care. Elective angiography revealed complete occlusion of the left anterior descending artery, and viability testing guided subsequent percutaneous coronary intervention, resulting in good functional recovery. An individualized antithrombotic regimen with a clear timeline was offered after a multidisciplinary team discussion. This case highlights the therapeutic challenges of ST-elevation myocardial infarction in patients with anticoagulated antiphospholipid syndrome, particularly in settings without primary percutaneous coronary intervention.

Keywords:
acute st myocardial infarctionanti-phospholipid antibodiesanti-phospholipid antibody syndrome (aps)percutaneous coronary interventionprimary pcist-elevation myocardial infarction (stemi)

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