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A case of late stent thrombosis in a patient hospitalized with COVID-19 called attention to the importance of antithrombotic therapy for those with coronary artery disease (CAD) who get infected, according to a case report from Spain.

An 81-year-old man presented in April 2020 with an anterior ST-segment elevation MI. Urgent coronary angiography revealed thrombotic occlusion of a durable-polymer ridaforolimus drug-eluting stent (DES) in the proximal left anterior descending (LAD) coronary artery.

This stent had been placed in a de novo lesion 3 months prior. It overlapped an older DES, coming from the left main, implanted 5 years prior, according to Fernando Alfonso, MD, PhD, of Hospital Universitario de La Princesa and Universidad Autónoma de Madrid, Spain, and colleagues reporting .

"To our knowledge, this is the first description of stent thrombosis in a patient with COVID-19," Alfonso's group said, suggesting a link between the two.

Optical coherence tomography revealed stent underexpansion, uncovered struts, and malapposition that may have predisposed the patient to stent thrombosis. Then COVID-19's hallmark "intense inflammatory and prothrombotic milieu" could have triggered the , they suggested.

"[B]ecause this is a single-case report, we are unable to establish that the episode of stent thrombosis was actually caused by COVID-19 disease. This also precludes generalizability of our findings to other patients with COVID-19," Alfonso and colleagues cautioned.

"However, these findings suggest that special care should be paid to optimize antithrombotic therapy in patients with COVID-19 with previous CAD," they concluded.

The case patient received mechanical thromboaspiration, which restored coronary flow but failed to retrieve visible thrombus. Balloon angioplasty left some residual thrombus but improved the expansion and malapposition.

Finally, the man was treated with tirofiban (Aggrastat), aspirin, and ticagrelor (Brilinta). A favorable clinical course was followed by discharge 2 days later.

The patient had been transferred from another hospital that had admitted him 10 days prior for COVID-19 with bilateral pneumonia. He had elevated inflammatory markers, including D-dimer (63 μg/mL), fibrinogen (850 mg/dL), lactate dehydrogenase (423 U/L), C-reactive protein (5.5mg/dL), and interleukin 6 (95 pg/mL). With hydroxychloroquine, azithromycin, and oxygen, the patient showed clinical improvement.

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