The Role of Anticoagulation in Acute Coronary Syndrome Patients with Coronary Artery Ectasia

Yi-De Chou,1,* Ting-Wei Lu,2,* Shu-I Lin,2 Han-En Cheng,3 Feng-Ching Liao,2 Chun-Wei Lee2 1Department of Ophthalmology, MacKay Memorial Hospital, Taipei, Taiwan; 2Cardiovascular Division, Department of Internal Medicine, MacKay Memorial, Hospital, MacKay Medical College, New Taipei, Taiwan; 3Faculty of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Chun-Wei Lee, Cardiovascular Center and Division of Cardiology, Mackay Memorial Hospital, 92, sec 2, Zhongshan North Road, Taipei, 10449, Taiwan, Tel +886-2-2543-3535 ext. 2456, Fax +886-2-2543-3535 ext. 2459, Email [email protected]: The coexistence of coronary artery ectasia (CAE) and acute coronary syndrome (ACS) is uncommon and associated with poor clinical outcomes. However, evidence regarding the role of anticoagulant therapy and covered stents in this context remains limited.Methods: To evaluate the potential impact of anticoagulant therapy in patients with CAE and ACS, we conducted a comprehensive systematic review of case reports and case series published up to August 2022.Results: Our findings suggest that anticoagulant therapy may be beneficial in preventing ACS in patients with CAE. The adjunctive use of single or dual antiplatelet therapy should be individualized based on bleeding risk. In addition, covered stents may represent a viable treatment option, particularly for short lesions.Conclusion: Patients with CAE often present with ACS and require tailored management strategies owing to altered vessel morphology and flow dynamics. Evidence from case series suggests that the combination of antiplatelet and anticoagulant therapy may reduce ischemic recurrence without a marked increase in bleeding events. Covered stents offer a viable intervention for short, isolated ecstatic segments.Keywords: coronary artery ectasia, acute coronary syndrome