, Volume 97, Issue 5, pp 345-347
Date: 10 Mar 2008

Antithrombotic triple therapy in a patient with multiple thrombi, subacute myocardial infarction and coronary stent implantation

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Sirs: A 53-years-old Lebanese male presented with acute chest pain (beginning 6–12 h before) and dyspnea. History-taking was incomplete since the patient does not speak German or English. His daughter negated any cardiac or thrombembolic events in the past. Diabetes and excessive smoking (more than 60 pack years) were identified as cardiovascular risk factors. The ECG showed a Q in the inferior leads (II, III, aVF) as well as a poor R wave progression in V2–V4 plus ST-elevations in V4–V6 indicating a (sub)acute anterior wall infarction. On admission troponin I (26.04 µg/l; reference value <0.1 µg/l), BNP (1,189 ng/l, reference value <100 ng/l) and D-Dimers were found increased (3.6 µg/ml; reference value <0.5 µg/ml), whereas creatinekinase was within the normal range. Echocardiography showed a reduced left ventricular function with anteroseptal, apical and posterobasal hypokinesia and multiple thrombi in the left atrium and both ventricles (Fig. 1d). Coronary angiography revealed a 3-v