A Rare Case of Essential Thrombocythemia Revealed by an Acute Coronary Syndrome: Management Difficulties and Therapeutic Challenges

Essential thrombocythemia is a clonal abnormality of the multipotent hematopoietic stem cell and results in an increased number of platelets. Patients are at risk of microvascular thrombosis and hemorrhage. The occurrence of an acute coronary syndrome may be a rare revealing mode of discovery of essential thrombocythemia. We report the case of a 67-year-old patient admitted for management of an acute coronary syndrome with the discovery during his assessment of a thrombocythemia reaching up to 966,000/mm3. in the context of the etiological assessment of the thrombocytosis, the diagnosis of essential thrombocythemia was retained. Acute coronary syndrome occurs in 9.4% of patients with essential thrombocytosis. In patients with ET, there is a vicious cycle in which the marked increase of activated platelets causes vascular endothelial damage, induces the instability of coronary plaque, evokes the rupture or erosion of the plaque, and consequently activates other resting platelet. The diagnosis of ACS in patients with essential thrombocythemia is similar to that of the general population, nevertheless in terms of treatment, Antithrombotic treatment remains a difficult decision to take. It is necessary to balance the risk of thrombosis and hemorrhage. the optimal long-term treatment of acute coronary syndrome is a dual antiplatelet therapy (DAT) with clopidogrel and Aspirin and adding Hydroxyurea to the DAPT makes the treatment optimal.