title: [ST-segment elevation myocardial infarction in a patient with thrombophilia taking new oral anticoagulants].
abstract: We report the case of a 65--year-old woman admitted for inferior ST-segment elevation myocardial infarction complicated by complete atrioventricular block. The patient was under treatment with a novel oral anticoagulant (NOAC, rivaroxaban) because of a history of recurrent idiopathic pulmonary embolism. Emergency angiography showed complete acute thrombotic occlusion of the right coronary artery. After manual thrombectomy, there was no angiographic evidence of underlying atherosclerosis, therefore no further percutaneous coronary intervention was performed. Subsequent clinical course was uneventful. Laboratory tests demonstrated the presence of a heterozygous mutation of the factor II gene (G20210A), confirming the clinical evidence of a thrombophilic state. As rivaroxaban seemed to be ineffective in preventing spontaneous coronary thrombosis in this patient, antithrombotic therapy was shifted to warfarin plus low-dose aspirin. No further ischemic events occurred during the 1-year follow-up. It can be hypothesized that factor Xa inhibition by NOACs, such as rivaroxaban, could be insufficient in case of a thrombophilic state due to thrombin mutation. A brief review of the current literature on use of NOACs in acute coronary syndromes is also reported.
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Mauro
authors.initials: M
authors.lastname: Li Calzi
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Angelo
authors.initials: A
authors.lastname: Placci
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Daniela
authors.initials: D
authors.lastname: Lina
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Francesca
authors.initials: F
authors.lastname: Grassi
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Paoli
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Michele
authors.initials: M
authors.lastname: Bianconcini
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Maria Alberta
authors.initials: MA
authors.lastname: Cattabiani
authors.affiliation: U.O.C. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma.
authors.forename: Alberto
authors.initials: A
authors.lastname: Menozzi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D000069552:Rivaroxaban / Q000627:therapeutic use*; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D019851:Thrombophilia; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban