Late stent thrombosis after paclitaxel-eluting stent placement in a patient with essential thrombocytosis

We report on a case of late stent thrombosis after drug-eluting stent placement in a patient with essential thrombocytosis. A 51-year-old male patient with a three-month history of paclitaxel-eluting stent placement to the left anterior descending artery presented with a complaint of severe retrosternal chest pain. A high platelet count (1,063,000/mm3) was detected two months prior to presentation, which was interpreted as essential thrombocytosis. He was on standard dual antiplatelet therapy (aspirin and clopidogrel). The electrocardiogram showed ST-segment elevation in leads V1-V6. Emergent coronary angiography revealed thrombotic total occlusion at the location of the paclitaxel-eluting stent. Balloon angioplasty was performed yielding a satisfactory result and TIMI 3 flow. Following the procedure, there was no chest pain. His platelet count was 388,000/mm3. He was discharged on medical therapy following an uneventful hospital course. Patients with essential thrombocytosis may not be eligible for drug-eluting stent placement.