Reactive Thrombocytosis Associated with Acute Myocardial Infarction following STEMI with Percutaneous Coronary Intervention.
The etiology of thrombocytosis can be classified into reactive and essential forms. The rate of thromboembolic events is higher in essential thrombocytosis, and these events include strokes, transient ischemic attacks, retinal artery or retinal vein occlusions, digital ischemia, and acute coronary syndrome. In a study of 732 medical and surgical patients with thrombocytosis, 88% had reactive thrombocytosis. Patients with reactive thrombocytosis do not require cytoreductive medications or antiplatelet treatment. We report a healthy 40-year-old man without any medical problems who developed a new episode of myocardial infarction associated with thrombocytosis after an episode of myocardial infarction followed by percutaneous coronary intervention. He had thrombocytosis, and his platelet function test did not reveal adequate inhibition. To treat his acute coronary syndrome, therapeutic enoxaparin was added, and clopidrogel was substituted with ticagrelor. We decided to start hydroxyurea to reduce platelets counts. Enoxaparin and hydroxyurea were discontinued when platelet count returned to baseline. JAK-2 and BCR/ABL mutations were negative. This case report highlights a clinical dilemma (reactive thrombocytosis), which is challenging in terms of management and pathophysiology.
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Nat
N
Dumrongmongcolgul
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Charoen
0000-0003-1210-3173
C
Mankongpaisarnrung
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Grerk
0000-0002-1311-6227
G
Sutamtewagul
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Nattamol
N
Hosiriluck
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Timothy
T
Chen
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Alexander
A
Trujillo
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Nicholas
N
Dcunha
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Kenneth
0000-0003-2781-4816
K
Nugent
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Indiana Avenue, Lubbock, TX 79430, USA.
Leigh Ann
LA
Jenkins