THROMBOCYTEMIE ESSENTIELLE REVELEE PAR UN INFARCTUS DU MYOCARDE : RISQUE HEMORRAGIQUE ET THROMBOTIQUE ELEVE _ PARTICULARITES DE LA PRISE EN CHARGE (A PROPOS DUN CAS)

Abstract

Essential thrombocythemia is a form of myeloproliferative syndromes, essentially characterized by the frequency of thrombotic, hemorrhagic and vasomotor complications. Despite the rarity of myocardial infarctions resulting from this pathology, the prognosis remains pejorative given the complexity of the therapeutic management. We report the case of a 70 years old patient with cardiovascular risk factors: well-balanced diabetes, untreated dyslipidemia, and obesity. Admitted for the management of an acute coronary syndrome with anterior ST segment shift overextended at H7 of pain, thrombolysis at H8 with failure. Not initially explored given the high thrombotic and hemorrhagic risk, linked to a thrombocytosis at 1200000/mm3 discovered fortuitously. An etiological assessment was launched confirming essential thrombocythemia, and the patient was put on an antiplatelet agent and a cytoreducer. Coronarographic exploration was recommended after the significant reduction in the platelet count, objectifying an angiographically normal coronary network. The diagnosis of myocardial infarction on resolved thrombus complicating essential thrombocythemia was retained. In the light of this observation, we discuss the difficulties of management related to this pathology and we expose our experience for the management and attenuation of the thrombotic and hemorrhagic risk.