Acute coronary syndrome with thrombocytopenia and megaloblastic anemia: A case report

In recent years, the application of aspirin for coronary artery disease has become increasingly common, and aspirin-related enteropathy has gradually garnered more attention. It has increasingly been recognized that the related enteropathy after the long-term use of NSAIDs may have potentially fatal side effects. However, it remains controversial how to select alternative medications for these patients with coronary heart disease, particularly for those who have recently undergone stent implantation. Our case presented with recurrent chest pain and coronary angiography revealed he had severe stenosis in the left anterior descending artery, nearly 90% at the opening, 80% at the middle segments, and a total occlusion at the distal segment, accompanied by a TIMI blood flow grade of 2. However, after five years of taking aspirin, the patient often felt fatigued and was found have megaloblastic anemia and thrombocytopenia. We attempted to prescribe indobufen as an alternative to aspirin for antiplatelet therapy. Fortunately, after several months of follow-up, the patient's symptoms were alleviated, and his hemoglobin and platelet levels returned to normal. Indobufen might be a potential alternative medication for these patients in clinical practice in the future.