# Short-term recurrent coronary artery thrombosis with acute myocardial infarction in a patient with aplastic anemia–paroxysmal nocturnal hemoglobinuria syndrome: a case report

## TL;DR

A patient with a rare blood disorder experienced repeated heart attacks due to unusual artery clotting, highlighting the need for careful monitoring and treatment.

## Contribution

This case report highlights the rare occurrence of recurrent coronary artery thrombosis in a patient with aplastic anemia–paroxysmal nocturnal hemoglobinuria syndrome.

## Key findings

- A patient with aplastic anemia–PNH syndrome experienced recurrent coronary artery thrombosis despite initial successful treatment.
- Recurrent thrombosis was confirmed via repeat coronary angiography and resolved with intensified anticoagulation.
- The case underscores the importance of close monitoring and tailored anticoagulation in managing thrombotic risks in this syndrome.

## Abstract

Acute myocardial infarction commonly occurs in patients with coronary artery disease, but rarely, it can develop under a hypercoagulable state. Aplastic anemia can be accompanied by paroxysmal nocturnal hemoglobinuria clones or transform into paroxysmal nocturnal hemoglobinuria with a significantly elevated prothrombotic state. These thrombotic complications predominantly arise in veins rather than in arteries. Coronary artery thrombosis in these patients, especially with short-term recurrent arterial thrombosis after initial successful treatment, is exceedingly rare.

A 39-year-old man with a history of aplastic anemia with paroxysmal nocturnal hemoglobinuria clones for 8 years presented with chest pain, and was diagnosed with acute inferior wall myocardial infarction on November 21, 2022. Despite standardized coronary intervention and anticoagulant/antiplatelet therapy, the patient reported intermittent chest discomfort with persistently elevated cardiac troponin and d-dimer levels 20 days after initial treatment. Repeat coronary angiography confirmed recurrent thrombosis in the right coronary artery. He underwent repeated balloon dilation and thrombus aspiration with intensified anticoagulation, which alleviated his clinical symptoms and normalized his cardiac troponin and d-dimer levels. The patient was finally confirmed to have aplastic anemia–paroxysmal nocturnal hemoglobinuria syndrome.

Patients with aplastic anemia–paroxysmal nocturnal hemoglobinuria syndrome can have thrombosis in arteries, such as coronary arteries, leading to acute myocardial infarction. Recurrent coronary artery thrombosis can occur after initial successful revascularization and anticoagulant/antiplatelet therapy. Close monitoring of clinical symptoms, repeated electrocardiogram and laboratory tests, coronary angiography, strengthened anticoagulation, and precautions for bleeding risks should be considered in patients with aplastic anemia–paroxysmal nocturnal hemoglobinuria syndrome.