A 62-year-old Japanese man presented with
chest pain indicating that acute
myocardial infarction had occurred. Eleven years earlier, he underwent a
splenectomy due to
idiopathic portal hypertension. Coronary angiography revealed diffuse
stenosis, with calcification in the left anterior descending coronary artery (LAD). We performed a primary
percutaneous coronary intervention (PCI). We deployed two
drug-eluting stents with sufficient minimal cross-sectional
stent area by intravascular ultrasound and thrombolysis in
myocardial infarction (TIMI) 3 flow. The initial laboratory examination revealed chronic
disseminated intravascular coagulation (
DIC). On the 8th hospital day, he developed
chest pain indicating early coronary
stent thrombosis, although he had been prescribed dual antiplatelet
therapy. We performed an emergent second PCI, and the TIMI flow grade improved from 0 to 3.
Clopidogrel was replaced with
prasugrel. On the 18th hospital day, we detected a repeated coronary
stent thrombosis again. We performed a third PCI and the TIMI flow grade improved from 0 to 3. After anticoagulation
therapy with
warfarin, the
DIC was improved and his condition ran a benign course without the recurrence of
stent thrombosis for 1 month. Contrast-enhanced CT showed portal vein
thrombosis. This patient's case reveals the possibility that the condition of chronic
DIC can lead to recurrent
stent thrombosis.
Stent thrombosis is infrequent, but remains a serious complication in terms of morbidity and mortality. Although
stent thrombosis is multifactorial, the present case suggests that
DIC is
a factor in
stent thrombosis. To prevent
stent thrombosis after PCI under
DIC, anticoagulation might be a treatment option in addition to antiplatelet
therapy.