A male patient with myocardial infarction as a first manifestation of antiphospholipid syndrome — treatment with rivaroxaban

Abstract

Data on the efficacy of non-vitamin K antagonist oral anticoagulants (NOAC) in the antiphospholipid syndrome (APS) are not clear. We present a case of a male patient aged 34 years with a history of myocardial infarction at the age of 25 treated conservatively, at that time associated with the risk factors including arterial hypertension, cigarette smoking, hypercholesterolaemia, and overweight. The notable laboratory finding observed for the first time was prolonged activated partial thromboplastin time (aPTT). At the age of 32 the patient experienced left-sided distal thrombosis of the lower limb and ischaemic stroke. The prolonged aPTT was further evaluated. APS testing was performed revealing the positive lupus anticoagulant, elevated anticardiolipin IgG antibodies and b-2-glicoprotein I IgG antibodies. Anticoagulant therapy with warfarin was initiated. Due to the disadvantages of the need for international normalised ratio monitoring, the treatment with rivaroxaban 20 mg daily was implemented according to the patient’s preferences. The patient has been taking the rivaroxaban for 15 months and has not experienced the recurrent venous and arterial thromboembolism. This case confirms that patients with APS who experienced arterial thrombosis may benefit from treatment with NOAC. Moreover, it emphasises the need for thrombophilia screening in patients aged 50 years and younger following the myocardial infarction, especially below 30 years even in the presence of cardiovascular risk factors. Recurrent thrombotic events following myocardial infarction, especially in the absence of coronary artery stenosis, should prompt search for acquired thrombophilia, especially APS, which predisposes to venous thromboembolism and ischaemic stroke.