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Case Reports
. 2025 Jul 7;17(7):e87433.
doi: 10.7759/cureus.87433. eCollection 2025 Jul.

ST-Elevation Myocardial Infarction Despite Adequate Anticoagulation in a Patient With Triple-Positive Antiphospholipid Syndrome: A Therapeutic Dilemma in a Resource-Limited Setting

Kajananan Sivagurunathan  1 , Nishadi Perera  1 , Anuranga Senanayake  1 , Jeyakanth Thangarajah  2
Affiliations
Case Reports

ST-Elevation Myocardial Infarction Despite Adequate Anticoagulation in a Patient With Triple-Positive Antiphospholipid Syndrome: A Therapeutic Dilemma in a Resource-Limited Setting

Kajananan Sivagurunathan et al. Cureus. .

Abstract

Antiphospholipid syndrome is a prothrombotic autoimmune disorder that can lead to arterial thrombotic events such as acute myocardial infarction. We report a case of a 40-year-old female with triple-positive antiphospholipid syndrome on therapeutic warfarin who presented with anterior ST-elevation myocardial infarction. With an international normalized ratio of 2.3, thrombolysis was contraindicated, and primary percutaneous coronary intervention was unavailable due to resource limitations. She was managed conservatively with enoxaparin, dual antiplatelet therapy, and supportive care. Elective angiography revealed complete occlusion of the left anterior descending artery, and viability testing guided subsequent percutaneous coronary intervention, resulting in good functional recovery. An individualized antithrombotic regimen with a clear timeline was offered after a multidisciplinary team discussion. This case highlights the therapeutic challenges of ST-elevation myocardial infarction in patients with anticoagulated antiphospholipid syndrome, particularly in settings without primary percutaneous coronary intervention.

Keywords: acute st myocardial infarction; anti-phospholipid antibodies; anti-phospholipid antibody syndrome (aps); percutaneous coronary intervention; primary pci; st-elevation myocardial infarction (stemi).

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The 12-lead electrocardiogram revealed ST elevation in leads V1 to V4, along with Q waves in V1 and V2 and terminal T wave inversions in leads V3 to V5, indicative of an evolving anteroseptal ST-elevation myocardial infarction.
Figure 2
Figure 2. Initial elective coronary angiogram following myocardial infarction (A) shows complete occlusion of the left anterior descending artery (arrow), while the post-percutaneous coronary intervention angiogram (B) demonstrates successful revascularization (arrowhead) with restoration of flow in the left anterior descending artery.
See this image and copyright information in PMC

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