Resolution of a spontaneous coronary artery thrombus with a new antiplatelet agent

A thrombus was observed in the left anterior descending coronary artery in a 47 year-old woman who presented with acute anterior myocardial infarction . On a coronary angiogram in the right oblique cranial position, the thromb us appeared as an eccentric, solid and homogeneous mass with a 22 mm maxima l length and 1.9 mm maximal diameter. The thrombotic segment and the rest o f the coronary tree was free of atherosclerosis. Due to the inappropriate c oronary structure and length of the thrombus, coronary angioplasty and/or s tent procedures were not performed. The patient refused coronary artery by- pass. She was given the glycoprotein IIb/IIIa inhibitor tirofiban 0.4 mug.k g(-1).min(-1) bolus over 30 minutes followed by 0.1 mug.kg(-1).min(-1) for 24 hours, orally acetylsalicylic acid 300 mg per day, nytroglicerin 40 mg p er day and warfarine with INR being in a range of 2-2.5 times. A control co ronary angiography performed two months later showed total dissolution of t he coronary thrombus and clearance of the culprit vessel.