Priapism: A very rare complication of dual antiplatelet therapy after percutaneous coronary intervention

Abstract

Context: Dual antiplatelet therapy (DAPT), with aspirin and P2Y12 receptor inhibitors, is standard of care in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, its use is associated with increased risk of bleeding. We herein report an unusual bleeding complication associated with DAPT after primary PCI. Case Report: A 42-year-old man, who presented with acute inferior wall MI and underwent a successful bare metal placement in circumflex coronary artery, was discharged on dual antiplatelet therapy. However, he presented 2 weeks later with priapism for 20 hours that needed surgical drainage of large amount of blood from his penis. There were no other causes to explain priapism, but since this was not known complication of DAPT, it was not discontinued given his recent stent placement. However, 3 weeks later he suffered another episode of priapism that also needed surgical drainage. Therefore, given its high antiplatelet potency, Prasugrel was eventually discontinued, and the patient was maintained on aspirin only. The decision was guided by optical coherence tomography evaluation of his recent stent to rule out local risks for stent thrombosis. The patient has done well over 14 months of follow up with no cardiac symptoms or recurrence of priapism. Conclusion: To the best of our knowledge, the association between priapism and DAPT was never reported previously. Given the wide use of DAPT after coronary intervention, we believe that interventional cardiologist should be aware of this rare, yet potentially devastating, complication.