Early coronary artery bypass graft thrombosis in a patient with protein S deficiency

Area of Science:

• Cardiovascular Surgery
• Hematology
• Vascular Medicine

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure for severe coronary artery disease.
• Graft failure can occur post-CABG, necessitating re-evaluation and potential further intervention.
• Protein S deficiency is a rare inherited condition that increases the risk of thrombosis.

Observation:

• A 59-year-old male presented with recurrent angina one month after undergoing emergency CABG for left main and right coronary artery stenosis.
• Angiography revealed occlusion of the bypass grafts.
• Preoperative hematological screening identified decreased levels of protein S.

Findings:

• The patient underwent a second operation to address the graft occlusion.
• Postoperatively, the patient was initiated on oral anticoagulant therapy.
• Hematological assessment confirmed protein S deficiency as a potential contributing factor.

Implications:

• Early identification and management of protein S deficiency are crucial in patients with recurrent thrombotic events after vascular surgery.
• Oral anticoagulant therapy can be effective in managing patients with protein S deficiency and preventing graft occlusion.
• This case highlights the importance of comprehensive hematological screening in patients with unexplained graft failure or thrombotic complications.