Acute coronary thrombosis following anabolic-androgenic steroid use in a female athlete: A case report

Anabolic-androgenic steroid (AAS) use has been associated with adverse cardiovascular events, including myocardial infarction. Proposed mechanisms include alterations in hemostasis and fibrinolysis, endothelial dysfunction, and abnormal vascular reactivity, potentially increasing susceptibility to coronary thrombosis. However, establishing a causal relationship in an individual patient requires careful exclusion of alternative etiologies. We report the case of a 45-year-old female fitness coach who presented with acute myocardial infarction following a six-week course of oxandrolone and methenolone in preparation for a bodybuilding competition. She had no conventional cardiovascular risk factors. Electrocardiography showed ST-segment elevation in the inferior leads. Coronary angiography revealed a large non-occlusive thrombus in the mid-right coronary artery with preserved TIMI 3 distal flow and no obstructive coronary artery disease. Optical coherence tomography confirmed a large adherent thrombus without visible intimal rupture. An extensive thrombophilia and autoimmune workup was unremarkable, and no cardiac source of embolism or in-hospital arrhythmia was identified. The temporal relationship with AAS exposure suggested a possible causal link. The patient was managed conservatively with intensive antithrombotic therapy, and follow-up coronary angiography at two months demonstrated complete thrombus resolution. This report highlights the potential association between AAS exposure and acute coronary thrombosis and discusses possible pathophysiological mechanisms, the diagnostic role of intracoronary imaging, and the individualized management of this uncommon presentation.