半月内反复心肌梗死青年患者1例

A young patient with recurrent myocardial infarction within a half month

1例青年男患者因胸痛急性发作就诊,诊断为急性心肌梗死;经规律药物及介入治疗后半月内仍反复发生心肌梗死3次。考虑患者血液存在高凝状态,予阿司匹林联合氯吡格雷等治疗,因检测提示患者对阿司匹林存在抵抗,故及时更换抗血小板药物,并联合抗凝治疗后未再发心肌梗死。复查冠状动脉造影未见明显狭窄。在有规律的药物治疗的基础上,冠状动脉介入治疗后患者仍出现反复发生的心肌梗死,应考虑到阿司匹林抵抗及血液呈高凝状态的可能。若遇到此类患者,应及时更换抗血小板药物,必要时需联合抗凝治疗,以免发生严重的后果。

In this study,we reported a young male patient with acute chest pain who was diagnosed as myocardial infarction.The regular medication was performed following coronary intervention.Under such condition,this patient had 3 times myocardial infarction within a half month.The laboratory results showed that there might be a state of hypercoagulability.Aspirin combined with clopidogrel and other treatment were administrated.Meanwhile,the examination demonstrated that there was aspirin-resistant in the patient.The antiplatelet drug and extended anticoagulation therapy were carried out.There was no further myocardial infarction,and no coronary arteries stenosis was found in the re-examination angiography.Aspirin resistance and hypercoagulability should be considered when patients occurred the repeated myocardial infarction after regular medication and coronary intervention.Replacement of the antiplatelet treatment or combination with anticoagulant therapy is necessary in similar patient to avoid the sever consequence.