A Case Report of Antiphospholipid Syndrome Presenting as Acute Myocardial Infarction with Severe Thrombocytopenia

doi:10.3969/j.issn.1002-1949.2025.03.013

Abstract：Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombotic events and persistent positivity of antiphospholipid antibodies. Cardiac involvement can manifest as acute myocardial infarction (AMI), but the combination of severe thrombocytopenia is rare clinically. This study reports a 75-year-old female patient who was admitted due to persistent chest pain. Electrocardiogram and dynamic changes in myocardial markers were consistent with acute non-ST-segment elevation myocardial infarction (NSTEMI). Laboratory findings showed severe thrombocytopenia (15 × 10^9/L), with positive results for anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, and lupus anticoagulant. Combined with her history of recurrent miscarriages and thrombotic events, she was diagnosed with APS. During treatment, there was a conflict between anticoagulation and bleeding risk. Initial treatment included glucocorticoids, nitrate drugs, and antiplatelet therapy, but platelet counts continued to decrease. Coronary angiography revealed severe multi-vessel stenosis, and percutaneous coronary intervention (PCI) with stent placement was performed. Subsequently, due to progressive decline in platelet count, the treatment plan was adjusted to rituximab combined with intravenous immunoglobulin, along with selatrelin. Platelet counts gradually increased to 35 × 10^9/L, and the patient was discharged in stable condition. This case highlights that for elderly patients presenting with AMI, if accompanied by thrombocytopenia and a history of thrombosis, APS should be considered. Early screening for antiphospholipid antibodies can help confirm the diagnosis. Treatment should balance anticoagulation and management of the underlying disease, with multidisciplinary collaboration and individualized strategies improving prognosis. This case provides important insights into the diagnosis and treatment of critical coronary events associated with APS.