In-situ coronary thrombosis without atherosclerosis in a young male: A case of multifactorial thrombophilia

Abstract We present the case of a 27-year-old male with an acute anterior Q-wave myocardial infarction due to in-situ thrombosis of the left anterior descending artery (LAD), with no angiographic signs of atherosclerosis. The clinical presentation revealed a multifactorial etiology involving immune activation (positive lupus anticoagulant, high SARS-CoV-2 IgG), genetic predisposition (heterozygous mutations in MTHFR, MTRR, PAI-1), and modifiable factors (smoking, stress). The case highlights diagnostic challenges in young patients without traditional risk factors, as well as the importance of adhering to validated APS testing protocols. Particular attention is drawn to the premature switch from warfarin to edoxaban, prompting reconsideration of anticoagulation strategy in the context of suspected APS. This report emphasizes the need for individualized evaluation and treatment planning in atypical arterial thrombosis, especially in the context of potential post-COVID immune dysregulation.