ST-segment elevation myocardial infarction in a patient with polycythemia vera managed with high-dose tirofiban pre-treatment, aspiration thrombectomy, and paclitaxel-eluting stent implantation

Abstract

While acute coronary syndromes inclusive of ST-elevation myocardial infarction (STEMI) have been described in patients with polycythemia vera (PCV), optimal pharmacologic and interventional management strategies in the setting of drastically elevated platelet counts remain unclear. To our knowledge this is the first reported case of STEMI with massive thrombus burden in a patient with PCV, treated successfully with high-dose tirofiban bolus and infusion, followed by staged aspiration thrombectomy and drug-eluting stent implantation. Whether a strategy of antiplatelet and antithrombotic pre-treatment prior to PCI with or without thrombectomy will consistently yield satisfactory outcomes in PCV patients presenting with acute coronary syndrome (ACS) or STEMI, remains a matter of speculation. Nevertheless, based on the relevant pathobiologic considerations and review of the available literature, we feel the strategy employed in this case to be a reasonable one when clinical circumstances render it feasible. © Touch Briefings 2011.