Deferred Stenting in a HIV Infected Patient with STEMI and Heparin Induced Thrombocytopenia

Abstract

Mohammed Al Jarallah, Rajesh Rajan, Ibrahim Mahmoud Elkhouly, Sarita Sunil and Raja Dashti

Coronary artery disease is one of the major cause of death in human immunodeficiency virus (HIV) positive patients. It can be due to endothelial dysfunction, hypercoagulability and inflammatory changes associated with HIV and highly active antiretroviral therapy (HAART) induced metabolic complications. This is one of the first reported deferred stenting in a HIV infected STEMI case withhistory of heparin-induced thrombocytopenia (HIT) positivity. Here we are reporting a 45-year-old Kuwaiti male who is known to be HIV positive as well as having heparin-induced thrombocytopenia presented to emergency room with acute ST elevation myocardial infarction (STEMI). We have opted for deferred stenting technique and performed angioplasty with drug eluting balloon (DEB) to the culprit vessel, the right coronary artery (RCA) under bivalirudin coverage. And on day 1 of the admission he underwent PCI to RCA with 2 drug-eluting stents (DES). Patient got discharged without any major complications on full anti ischemic treatment. PCI in HIV STEMI patients with HIT are related to major complications like restenosis, in-stent thrombosis hence initial management of deferred stenting is ideal.

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