Interv Akut Kardiol. 2010;9(6):316-318

Is there any link between myocardial reinfarction after a major orthopedic surgery

Tomáš Roubíček, Vladimír Hraboš

Kardiocentrum Krajské nemocnice Liberec a. s.

and a lack of effectiveness of antiplatelet therapy ?

Extensive orthopedic procedures, such as total hip replacement, represent an important thrombotic state of the organism as a response

to tissue injury. We present a 63 years old patient who suffered an acute myocardial infarction as a first symptom of coronary heart

disease early after orthopedic surgery. Myocardial infarction was treated by urgent percutaneous coronary intervention of the right

coronary artery. The patient was taking dual antiplatelet therapy (aspirin and clopidogrel). The patient suffered myocardial re-infarction

due to stent thrombosis on day 9. Optical aggregometry using inducers arachidonic acid and ADP confirmed the lack of effectiveness

of antiplatelet therapy. For this reason, prasugrel therapy was initiated with good effect on platelet aggregation. Follow-up tests of

platelet aggregation after 3 months demonstrated normal sensitivity to aspirin with the lasting good effect of prasugrel. This case study

shows that platelet aggregation is a dynamic process which is influenced by many factors. Different mechanisms leading to thrombotic

state, including a major orthopedic surgery, may temporarily reduce the effect of antiplatelet drugs.

Keywords: thrombotic state, in-stent thrombosis, prasugrel

Published: December 10, 2010  Show citation