Secondary Antiphospholipid Syndrome with Recurring Acute Coronary Events

Abstract

A BSTRA C T A 41-year-old gentleman with a recent history of Hodgkin’s lymphoma sustained an acute inferior wall myocardial infarction, managed with percutaneous coronary intervention, thromboaspiration and stenting in a totally occluded right coronary artery. He was placed on triple antithrombotic treatment with dual antiplatelet therapy and oral anticoagulation because of a large thrombotic load in the right coronary artery. Three months later and 5 days after discontinuation of prescribed oral anticoagulant, he had a new acute coronary event due to acute reocclusion in the right coronary artery. Thrombus aspiration and repeat angioplasty restored vessel patency. The patient was put back on triple antithrombotic therapy and was investigated for uncommon causes of blood hypercoagulability. Blood assays revealed elevated anti-β2 glycopro tein I (anti-β2GPI) (IgM) and anticardiolipin antibodies (IgM), consistent with a diagnosis of secondary antiphospholipid syndrome.