Myocardial infarction in a 35-year-old man with homocysteinemia, high plasminogen activator inhibitor activity, and resistance to activated protein C

Metabolism: Clinical and Experimental
Charles J GlueckM Alasmi

Abstract

Our specific aim was to examine the interface between risk factors for atherosclerosis, thrombosis, and hypofibrinolysis in a previously healthy 35-year-old male who had sustained a recent myocardial infarction. By angiography, the right, left main, and left anterior descending coronary arteries were smooth-walled, widely patent, and free of significant obstruction; the circumflex exhibited total, probably thrombotic occlusion of the distal large second marginal branch. The patient was found to have prothrombotic high homocysteine (46.4 mumol/L), prothrombotic resistance to activated protein C (ratio, 1.47), and hypofibrinolytic high plasminogen activator inhibitor (PAI-Fx) activity (54 U/mL). He was homozygous for the 677C-->T; A-->V mutation in the methylenetetrahydrofolate reductase (MTHFR) gene causing homocysteinemia, heterozygous for the mutant factor V Leiden gene causing resistance to activated protein C, and heterozygous for the 4G/5G polymorphism in the PAI-1 promoter gene causing high PAI-Fx. Other major risk factors for coronary artery disease included previously undiagnosed adult-onset diabetes, high triglycerides (291 mg/dL), and low high-density lipoprotein (HDL) cholesterol (26 mg/dL). The patient's prothromboti...Continue Reading

References

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Citations

Jan 5, 2002·Expert Opinion on Investigational Drugs·C J GlueckP Wang
Jan 11, 2000·Clinical Orthopaedics and Related Research·C J GlueckP Wang
May 5, 2005·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Meral KaykçoğluCuneyt Turkoglu
May 12, 2001·Clinical Orthopaedics and Related Research·C J GlueckP Wang

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