Metachronous thromboses and myocardial infarctions in a 32-year-old woman with antiphospholipid antibodies

Metachronous thromboses in multiple vascular beds in a patient younger than 40 years is often suggestive of an acquired or congenital thrombophilic disorder. We present the case of a 32-year-old African American woman who presented to the emergency room with a painful right neck mass and a right hemispheric transient ischemic attack. She had 2 prior admissions for recurrent myocardial infarctions, hypertensive crises, congestive heart failure, and a left ventricular thrombus. Her warfarin therapy expired 2 weeks before her current admission. Our expanded evaluation for thrombophilia revealed high antiphospholipid antibody levels. High-dose anticoagulants were administered without further recurrence or complications. The antiphospholipid antibody syndrome should be considered early in the differential diagnosis as an important cause of recurrent, unusual, or unexplained thromboses in young patients. Education and patient compliance are vital to successful long-term medical management.