Thrombosis of Coronary Arteries in a Patient With Polycythemia Vera During the Myocardial Revascularization: A Case Report

Abstract

Coronary artery bypass grafting in a patient suffering from polycythemia vera is clinically rare and extremely challenging. There is no established protocol regarding the management of these patients because the number of patients in this circumstance is very small. Expressed thrombotic risk in patients suffering from polycythemia vera is highly emphasized in patients with coronary artery disease. Only a few cases have been reported of performing coronary artery bypass grafting, and in those cases a successful outcome seems to be an exception. We report a case of a 73-year-old male caucasian patient suffering from frequent daily chest pain and unstable angina with a 75% stenosis of the left main coronary artery and a subocclusion of proximal right coronary artery undergoing coronary artery bypass grafting, where despite following all the management algorithms and hematologic and cardiologic guidelines properly during the preoperative workup, the patient had a complex postoperative recovery with thrombosis of native coronary vessels—the left anterior descending artery and right coronary artery. Further investigation is needed regarding the effect of deciding between strategies in the domain of cardiac surgery as well as in the hematologic domain on the final outcome. It would be absolutely necessary to conduct a global trial to investigate the preferred cardiosurgical procedure (OPCAB or on-pump CABG).