Recurrent Thrombosis in a Case of Coronary Ectasia with Large Thrombus Burden Successfully Treated by Adjunctive Warfarin Therapy

Coronary ectasia (CE) is an uncommon disease. Most patients with CE have coexisting coronary artery stenosis, which can easily lead to acute myocardial infarction (AMI). The current standard treatment for AMI is well-established. However, for CE patients, the standard treatment might fail because of the large thrombus burden. We report a case of CE suffering from AMI twice during a two week period. Percutaneous coronary intervention with aspiration thrombectomy was performed but failed to restore adequate blood flow. Heparin and antiplatelet treatment including glycoprotein IIb/IIIa inhibitor was given for pharmacological management, but follow-up angiography still revealed a poor result. This patient was finally treated with dual antiplatelet therapy in combination with warfarin treatment. Follow-up coronary angiography a few months later showed restored TIMI 3 flow. This patient reminds us that in CE patients with large thrombus burden, if standard treatment fails, long-term warfarin in combination with antiplatelet might be a good alternative choice to decrease thrombus burden and enhance blood flow. Key Words: Acute myocardial infarction Anticoagulation Aspiration thrombectomy Coronary ectasia Warfari