A case of acute myocardial infarction in a patient with essential thrombocythaemia treated with anagrelide
  • Ekrem Yetiskul
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Aqsa Nisar
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Salman Khan
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Faris Qaqish
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Danyal Khan
    Department of Cardiology, Staten Island University Hospital, Staten Island, USA
  • Alexander Bershadskiy
    Department of Hematology and Oncology, Staten Island University Hospital, Staten Island, USA

Keywords

Essential thrombocythaemia, anagrelide, myocardial infarction, thrombosis

Abstract

Anagrelide is a medication primarily used to manage thrombocytosis, an abnormal increase in platelet levels in the blood. It is often prescribed for patients with myeloproliferative disorders, such as essential thrombocythaemia (ET). Given the heightened susceptibility to thromboembolism associated with this condition, the primary emphasis in treatment revolves around reducing the risk of thrombotic events through the administration of cytotoxic agents. While anagrelide is generally effective in reducing platelet counts, it comes with potential side effects, including an increased risk of certain thrombotic events. Anagrelide acts by inhibiting megakaryocyte maturation and platelet release, thereby reducing platelet production. However, this platelet-lowering effect may be accompanied by an increase in platelet activation and reactivity, which could contribute to a prothrombotic state. We present a case of a 60-year-old female with a history of ET, managed with anagrelide and hydroxyurea therapy, who experienced an acute ST-elevation myocardial infarction.

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References

  • Babakhanlou R, Masarova L, Verstovsek S. A review of essential thrombocythemia and its complications. Clin Adv Hematol Oncol 2023;21:76–84.
  • Mizuta E, Takeda S, Sasaki N, Miake J, Hamada T, Shimoyama M, et al. Acute myocardial infarction in a patient with essential thrombocythemia: successful treatment with percutaneous transluminal coronary recanalization. Circ J 2005;69:1000–1002.
  • Besses C, Alvarez-Larran A. How to treat essential thrombocythemia and polycythemia vera. Clin Lymphoma Myeloma Leuk 2016;16:Suppl:S114–123.
  • Lim Y-H, Lee YY, Kim JH, Shin J, Lee JU, Kim K-S, et al. Development of acute myocardial infarction in a young female patient with essential thrombocythemia treated with anagrelide: a case report. Korean J Hematol 2010;45:136–138.
  • Cervantes F. Management of essential thrombocythemia. Hematology Am Soc Hematol Educ Program 2011;2011:215–221.
  • Ashorobi D, Gohari P. Essential thrombocytosis. [Updated 2023 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539709/?report=classic
  • Bieniaszewska M, Sobieralski P, Leszczynska A, Dutka M. Anagrelide in essential thrombocythemia: efficacy and long-term consequences in young patient population. Leuk Res 2022;123:106962.
  • Brière JB. Essential thrombocythemia. Orphanet J Rare Dis 2007;2:3. doi: 10.1186/1750-1172-2-3.
  • Soucy-Giguère M-C, Turgeon PY, Sénéchal M. What cardiologists should know about essential thrombocythemia and acute myocardial infarction: report of two cases and advanced heart failure therapies considerations. Int Med Case Rep J 2019;12:253–259.
  • Vianello F, Cella G, Osto E, Ballin A, Famoso G, Tellatin S, et al. Coronary microvascular dysfunction due to essential thrombocythemia and polycythemia vera: the missing piece in the puzzle of their increased cardiovascular risk? Am J Hematol 2015;90:109–113.
  • Rossi C, Randi ML, Zerbinati P, Rinaldi V, Girolami A. Acute coronary disease in essential thrombocythemia and polycythemia vera. J Intern Med 1998;244:49–53.
  • Carobbio A, Thiele J, Passamonti F, Rumi E, Ruggeri M, Rodeghiero F, et al. Risk factors for arterial and venous thrombosis in WHO-defined essential thrombocythemia: an international study of 891 patients. Blood 2011;117:5857–5859.
  • Beer PA, Erber WN, Campbell PJ, Green AR. How I treat essential thrombocythemia. Blood 2011;117:1472–1482.
  • Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med 1995;332:1132–1136.
  • Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–245.
  • Tanaka R, Gotate Y, Sujino Y, Fukushima K, Todo M, Ohta A, et al. Anagrelide potentially provokes acute coronary syndrome even in an adolescent affected with essential thrombocythemia concomitant with underlying persistent coronary endothelial dysfunction. Authorea 2020;11:doi: 10.22541/au.158921467.78099904
  • Ahluwalia M, Donovan H, Singh N, Butcher L, Erusalimsky JD. Anagrelide represses GATA-1 and FOG-1 expression without interfering with thrombopoietin receptor signal transduction. J Thromb Haemost 2010;8:2252–2261.
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    Published: 2024-02-28
    Issue: 2024: Vol 11 No 3 (view)


    How to cite:
    1.
    Yetiskul E, Nisar A, Khan S, Qaqish F, Khan D, Bershadskiy A. A case of acute myocardial infarction in a patient with essential thrombocythaemia treated with anagrelide. EJCRIM 2024;11 doi:10.12890/2024_004340.

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