NSAID use, specifically diclofenac, in a patient on therapeutic anticoagulation was associated with a 100% occlusion of the mid LAD artery leading to anterior STEMI.
NSAID use can precipitate severe platelet-driven thrombotic events such as STEMI even in patients who are adequately anticoagulated with vitamin K antagonists.
Absolute Event Rate: 0% vs 0%
Background: Acute coronary syndrome (ACS) in young adults is uncommon. The case of a 34-year-old male, post mechanical mitral valve replacement (MVR), who developed anterior ST-elevation myocardial infarction (STEMI) despite therapeutic anticoagulation (INR 3.17), shortly after the initiation of diclofenac, highlights an important clinical scenario. Case Presentation: The patient presented with atypical upper back pain and was diagnosed with anterior STEMI. Coronary angiography revealed a 100% thrombotic occlusion in the mid left anterior descending (LAD) artery. Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed. Importantly, the patient had no history of hypercoagulable states or atherosclerosis and had been compliant with oral anticoagulation therapy. He had been initiated on diclofenac therapy nine days prior to symptom onset. Conclusion: This case highlights the serious thrombotic risks associated with NSAID use, even in patients adequately anticoagulated with acenocoumarol. It underscores the necessity of careful NSAID prescribing and demonstrates that therapeutic INR does not offer protection from platelet-driven thrombotic events.
Hasanfatta et al. (Wed,) reported a other. NSAID use, specifically diclofenac, in a patient on therapeutic anticoagulation was associated with a 100% occlusion of the mid LAD artery leading to anterior STEMI.