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Case Reports in Medicine
Volume 2016, Article ID 2312078, 4 pages
http://dx.doi.org/10.1155/2016/2312078
Case Report

Simultaneous Two-Vessel Subacute Stent Thrombosis Caused by Clopidogrel Resistance from CYP2C19 Polymorphism

1Department of Internal Medicine and Division of Cardiology, New York Methodist Hospital, Brooklyn, NY 11215, USA
2Surat Municipal Institute of Medical Education and Research, Umarwada, Surat, Gujarat 395010, India
3Department of Cardiology, Guthrie Clinic, Sayre, PA 18840, USA

Received 16 April 2016; Accepted 5 July 2016

Academic Editor: Michael S. Firstenberg

Copyright © 2016 Ashwad Afzal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Clopidogrel resistance from CYP2C19 polymorphism has been associated with stent thrombosis in patients undergoing percutaneous coronary intervention with drug-eluting stents. We present a case of a 76-year-old male who received drug-eluting stents to the right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction and was discharged on dual antiplatelet therapy with aspirin and clopidogrel. He subsequently presented with chest pain from anterior, anteroseptal, and inferior ST segment elevation myocardial infarction. An emergent coronary angiogram revealed acute stent thrombosis with 100% occlusion of RCA and LAD that was successfully treated with thrombus aspiration and angioplasty. Although he was compliant with his dual antiplatelet therapy, he developed stent thrombosis, which was confirmed as clopidogrel resistance from homozygous CYP2C19 polymorphism.