Multivessel coronary artery stenting complicated by stent thrombosis in the setting of hereditary thrombophilia: a clinical case

An urgent issue remains to determine the role and significance of gene polymorphism encoding components of the blood coagulation and anticoagulation system in increasing the risk of myocardial infarction and its thrombotic complications, including those associated with coronary artery stenting. This article presents a clinical case of a patient with multivessel coronary artery disease and hereditary thrombophilia — polymorphism of thrombophilia genes (heterozygote F13, ITGA2). This condition was accompanied by dramatic progression of recurrent stent thrombosis and recurrent myocardial infarction, despite ongoing triple and subsequently dual antithrombotic therapy. Repeated thrombosis necessitated surgical revascularization via coronary artery bypass surgery. Hereditary thrombophilic conditions may contribute to the multifactorial nature of stent thrombosis development, complicating both the diagnosis of its causes and the choice of antiplatelet and anticoagulant therapy options, especially given the limited time frame in cases of acute stent thrombosis. Risk factors for stent thrombosis in this clinical case include hereditary thrombophilia, multivessel coronary artery disease involving the left main coronary artery, multiple stent implantation, myocardial infarction, and repeated revascularization. A number of gene mutations associated with an increased risk of thrombosis were identified, which may have varying clinical significance. However, from the perspective of genetic polymorphism, it is not possible to completely rule out their influence. Regarding the choice of antithrombotic therapy in patients with congenital thrombophilia, recurrent or treatment-resistant thromboses of unknown etiology, rare blood clots localization, randomized clinical trials on the efficacy of direct oral anticoagulants remain insufficient. Therefore, warfarin remains the treatment of choice for this specific group group of patients. Diagnosis of hereditary thrombophilic conditions influences the choice of rational therapy and secondary prevention of thrombotic complications.

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