aplastic anemia is a form of anemia in which the bone marrow fails to produce adequate numbers of peripheral blood elements .
the incidences of atherosclerosis and myocardial infarction in patients with congenital coagulation disorders and chronic thrombocytopenia are very low . however in cases requiring invasive procedures ( e.g. , dental procedure and endoscopic procedure ) , patients at times need platelet transfusion . in this paper , a case of late stent thrombosis was reported within 4 hours after transfusion of platelets for anticipated bleeding in an aplastic anemia patient .
a 52-year - old man who had been diagnosed with aplastic anemia and stable angina visited the emergency room of the authors ' hospital with a complaint of chest pain .
the chest pain had developed 1 hour before the patient 's arrival at the hospital .
the initial electrocardiogram showed a hyperacute tall t wave in the precordial leads ( fig .
the cardiac markers were in the normal range , but thrombocytopenia was noted ( initial white blood cell count : 3350 , hemoglobin : 12.5 g / dl , platelet : 45000/l ) .
his past history revealed that he had been admitted to a hospital a year ago for acute coronary syndrome and percutaneous coronary intervention ( pci ) of the left anterior descending artery ( lad ) , for which a cypher select stent ( 3.528 mm , johnson & johnson - cordis , miami , fl , usa ) procedure was performed ( fig .
he had been taking 100 mg of aspirin , 75 mg of clopidogrel and 100 mg of oxymetholone ( anabolic steroids ) for aplastic anemia daily since the last one year .
however , he had stopped taking aspirin and clopidogrel for 3 days before presenting himself at the hospital since he was scheduled to be treated for a decayed tooth .
his laboratory findings showed that he had severe thrombocytopenia ( platelet count : 12000/l ) .
therefore , transfusion of 6 pints of platelet concentrates was performed on the same day of the patient 's visit to the hospital .
a dose of 7,000 units of unfractionated heparin was injected during the cag with another loading dose of 300 mg of clopidogrel .
after the pci , the chest pain subsided . on the second day , blood started oozing from the puncture site , hence a manual compression dressing was applied for 1 hour , after which there was no more complications .
on the 12th day , the patient 's dental caries was treated with tooth extraction without bleeding complications , and the patient was discharged .
he was also asked to continue oxymetholone ( anabolic steroids ) therapy for aplastic anemia .
aplastic anemia is a form of anemia in which the bone marrow fails to produce adequate numbers of peripheral blood elements .
the incidences of atherosclerosis and myocardial infarction in patients with congenital coagulation disorders and chronic thrombocytopenia are very low .
there are a few reports of cases of aplastic anemia associated with myocardial infarction during treatment with anabolic steroids.1 ) steroids have been commonly used to treat aplastic anemia , are a possible risk factor for coronary thrombosis , because steroids have an accelerating effect on metabolic changes and can induce a hypercoagulable state , each of which may promote atherosclerosis .
therefore , steroids may have helped to precipitate the clinical events in the patient.2 ) andrade et al.3 ) reported a case of acute stent thrombosis in a patient with giant cell arteritis , but there is no case report of long - term oral steroid therapy associated with very late stent thrombosis .
even if other risk factors for stent thrombosis ( e.g. , incomplete stent expansion or clopidogrel resistance ) , according to time sequence , could not be completely excluded , platelet concentrate transfusion might have played an important role in coronary stent thrombosis in this study .
sabovic and simona4 ) suggested that a substantial number of platelets and whole blood transfusions might be risk factors for coronary thrombosis .
that is , plasminogen activator inhibitor - ii , a strong prothrombotic factor , which accumulates in stored blood products in a time - dependent manner , could extensively increase in the plasma after transfusions .
this prediction , which may be clinically relevant , must be further clarified.5)6 ) unfortunately , this marker or other coagulation factors have not been examined .
cornet et al.7 ) reported three case studies of coronary stent occlusion after platelet transfusion .
actually , since peri- or intra - procedural massive bleeding was noted in all three cases , platelet transfusion was done inevitably . in our case , one could argue that platelet transfusion was not necessary in a patient who was scheduled for a minor dental procedure .
the use of intravenous immunoglobulin ( ivig ) concomitant with platelet transfusion is indicated in patients with life - threatening severe thrombocytopenia or hemorrhage , or when therapeutic procedures with some risk of bleeding are performed.8 ) ivig should be administered only after careful consideration of the risks and benefits , and should be reserved for patients at risk of severe hemorrhage , and the use of a bare - metal stent over a drug - eluting stent should always be considered as the first option.9 - 11 ) in conclusion , the authors ' observations emphasize the risks of platelet transfusion and support withholding such a treatment unless vitally indicated , in patients with coronary artery stent implantation and even in those on dual antiplatelet therapy .
 aplastic anemia is a condition in which the bone marrow fails to produce adequate numbers of peripheral blood elements . 
 the incidences of atherosclerosis and myocardial infarction in patients with congenital coagulation disorders and chronic thrombocytopenia are very low . in this paper , a case of late stent thrombosis within a drug - eluting stent occurring after platelet transfusion in a patient with aplastic anemia is presented . 
 the authors ' observations emphasize the risks of platelet transfusion and the authors ' support withholding such a treatment unless vitally indicated , in patients with coronary artery stent implantation and even in those on dual antiplatelet therapy . 
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