Open AccessACUTE MYOCARDIAL INFARCTION WITH VITAMIN B12 DEFICIENCY AND MILD HYPERHOMOCYSTEINEMIA: A CASE REPORT AND REVIEW
Author(s) -
Bijoy Kumar Panda,
Siddhi Umarje,
Madhu Bansode
Publication year - 2016
Publication title -
asian journal of pharmaceutical and clinical research
Language(s) - English
Resource type - Journals
eISSN - 2455-3891
pISSN - 0974-2441
DOI - 10.22159/ajpcr.2016.v9i6.13841
Subject(s) - medicine , clopidogrel , ticagrelor , aspirin , hyperhomocysteinemia , acute coronary syndrome , myocardial infarction , discontinuation , vitamin b12 , statin , cardiology , homocysteine
A 38-year old male was diagnosed with acute myocardial infarction (AMI) without a history of any significant clinical conditions. His subjective complaints and objective findings were clearly suggesting an acute ischemic attack along with vitamin B12 deficiency. While managing him for AMI, serology tests for vitamin B12 revealed low levels along with mild elevation of serum homocysteine level. He was managed with thrombolytic agent, β-adrenergic blocker, aspirin, antiplatelet agents, anticoagulants, statin, vitamin B complex and folic acid supplements. The clinical pharmacist intervened by suggesting discontinuation of Clopidogrel as two antiplatelet agents (Clopidogrel and Ticagrelor) were administered along with an anticoagulant, thereby increasing the risk of bleeding in the patient. Clopidogrel was stopped as Ticagrelor is a better antiplatelet agent when given in combination with low dose aspirin. Also, aspirin dose was reduced to enhance the efficacy of Ticagrelor and provide better secondary prevention for vascular diseases.