Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature

Essential thrombocythaemia (ET) is a chronic myeloproliferative disorder characterized by a sustained elevated platelet count with a tendency to both thrombosis and hemorrhage [1,2]. In ET the median age of presentation is 60 years with female predominance [3] and has a favorable outcome [4]. A small subset of patients is being diagnosed at an earlier age [5,6]. Young women with ET constitute a special group due to their anticipated long survival and childbearing potential [7-9]. Pregnancies in ET patients are likely to be complicated, primarily due to first trimester spontaneous abortions but for those carried to term, obstetric or thrombohemorrhagic complications are rare [10].Pregnancy is an acquired risk factor for thromboembolism associated with increased coagulation and decreased fibrinolysis [11]. Hemodynamic and hormonal alterations during pregnancy may further potentiate the risk of vascular events [12,13]. Although rare, acute myocardial infarction does complicate pregnancy and is estimated to occur in about 6 per 100,000 women during the peripartal period [14].Pregnancy-related complications in patients with ET remains a challenge as platelet count has not been shown to represent a risk factor for pregnancy complications, nor the use of aspirin has been demonstrated to influence pregnancy outcome [9]. We describe a case involving recurrent non-ST elevation myocardial infarction in the immediate postpartum period in a young woman with ET. We review the current literature for pregnancy-related risk factors of myocardial infarction with respect to ET.A 40-year-old caucasian woman, gravida 3 para 2, developed postpartal arterial hypertension. Her first pregnancy, three years earlier, had been complicated by an early spontaneous abortion at gestational week 7. In the following pregnancy, one year later, while on prophylactic low-molecular weight heparin due to the previous miscarriage, a cesarean section was performed at gestational week 32 due to intrauterine