OVERLAPPING ANTITHROMBOTIC THERAPY AND OMITTED SECONDARY PREVENTION IN AN EVOLVED INFERIOR WALL MYOCARDIAL INFARCTION WITH HYPERTENSION: A CLINICAL PHARMACIST-LED CASE ANALYSIS

Inferior wall myocardial infarction is conventionally regarded as carrying a favourable prognosis, yet the antithrombotic regimens used to treat it are among the highest-risk prescriptions written in any hospital ward. We describe a 51-year-old man admitted to the intensive coronary care unit of a tertiary care teaching hospital with typical chest pain of one day’s duration and a known but entirely untreated history of hypertension. His admission blood pressure was 160/100 mmHg, two-dimensional echocardiography demonstrated inferior wall hypokinesia with a left ventricular ejection fraction of 41%, and a diagnosis of evolved inferior wall myocardial infarction with hypertension was made. A structured medication review performed by the clinical pharmacy team using the Pharmaceutical Care Network Europe classification identified eight drug-related problems. The most significant were two platelet P2Y₁₂ receptor inhibitors on the same chart without a documented switching strategy, a prophylactic-intensity enoxaparin dose overlapping a therapeutic unfractionated heparin infusion, and omission of a beta-blocker, a renin-angiotensin system inhibitor and any antihypertensive agent despite reduced systolic function and uncontrolled blood pressure. The discharge prescription supplied dual antiplatelet therapy and a statin for only seven days. The patient left hospital clinically stable and without bleeding, but with a regimen that was unlikely to protect him beyond the first week. This case illustrates how a single conservatively managed infarction can accumulate multiple interacting, preventable and largely invisible drug-related problems, and argues for structured pharmacist-led prescription review at both the bedside and the point of discharge.