Key result
A 44-year-old male presented with a rare combination of STEMI, pulmonary embolism, and ischemic stroke driven by underlying thrombophilia, lung cancer, and recent COVID-19 infection.
Why the study?
Ischemic stroke, PE, and STEMI rarely co-occur in young patients without classical risk factors, and understanding etiology beyond atherosclerosis in the setting of COVID-19 and thrombophilia is critical.
Case Report (n=1)
This case highlights the potential for severe, multi-vascular thrombotic events in young patients with overlapping prothrombotic conditions such as COVID-19, malignancy, and underlying thrombophilia.
Answers are grounded in this paper and cite their sources.
May support thrombophilia testing in select young patients with concurrent stroke, PE, and STEMI; leaves open need for prospective validation.
BACKGROUND: Ischemic stroke, pulmonary embolism (PE), and acute ST-segment elevation myocardial infarction (STEMI) are very rarely all present in younger patients without classical risk factors or a family history of dyslipidemia or cardiovascular disease. They represent a medical emergency and necessitate fast diagnosis, treatment, and search for etiology, not explained purely by atherosclerosis. Thrombophilia testing should be considered in younger patients with several major thrombotic episodes, although there is much disagreement concerning the importance of homocysteine level testing in patients with arterial and venous thrombotic events, including PE. COVID-19 infection may trigger several thrombotic complications caused by unique immunothrombotic processes. CASE PRESENTATION: A 44-year-old patient complaining of chest pain was admitted at our clinic due to acute anterior STEMI. He has a previous medical history of ischemic stroke, COVID-19 infection, and PE in the past 2 months. Newly, diagnosed lung adenocarcinoma was confirmed by biopsy 10 days before STEMI admission, without surgical or previous hemotherapy. The patient was on regular anticoagulant therapy with rivaroxaban 20 mg OAD and antiplatelet therapy with Aspirin due to previous PE and ischemic stroke. Patient denied standard risk factors, family history for cardiovascular disease or any previous minor or major bleedings, history of anemia, liver, or renal dysfunction. Acute stroke was confirmed by brain computed tomography imaging. Thrombophilia panel testing revealed homozygote mutations for MTHFR 677 gene, heterozygote mutation for integrin subunit alpha 2, and fibrinogen B beta chain) genes. The patient was treated with low molecular weight heparin, aspirin, clopidogrel, and heart failure therapy in the acute phase. Clinical consultations were performed with a team of doctors which included a cardiologist, neurologist, and oncologist. Patients have a high bleeding risk, assessed by HAS-BLEED score of 4. CONCLUSION: Our patient is a rare case of serious multi-vascular thrombotic events with underlying thrombophilia, lung cancer, and past COVID-19 infection complicated by pulmonary embolism, ischemic stroke, and STEMI.
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Mitevska et al. (2023) conducted a case report in STEMI, pulmonary embolism, ischemic stroke, lung carcinoma, COVID-19 (n=1). Low molecular weight heparin, aspirin, clopidogrel, and heart failure therapy was evaluated. A 44-year-old male presented with a rare combination of STEMI, pulmonary embolism, and ischemic stroke driven by underlying thrombophilia, lung cancer, and recent COVID-19 infection.
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