American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Case Reports. 2020, 8(9), 262-267
DOI: 10.12691/ajmcr-8-9-2
Open AccessArticle

Management of ST-Elevation Myocardial Infarction in the COVID-19 Era: The Role of Thrombosis and Anticoagulation Strategy

Mohammed Al-Sadawi1, Amena Mohiuddin1, Naseem Hossain1, Shakil Shaikh2, Alan Feit2, Benjamin Ramalanjaona1, Moro O. Salifu1 and Samy I. McFarlane1,

1Department of Medicine, SUNY Downstate health Sciences University, Brooklyn, NY

2Division of Cardiovascular Medicine, SUNY Downstate health Sciences University, Brooklyn, NY

Pub. Date: May 22, 2020

Cite this paper:
Mohammed Al-Sadawi, Amena Mohiuddin, Naseem Hossain, Shakil Shaikh, Alan Feit, Benjamin Ramalanjaona, Moro O. Salifu and Samy I. McFarlane. Management of ST-Elevation Myocardial Infarction in the COVID-19 Era: The Role of Thrombosis and Anticoagulation Strategy. American Journal of Medical Case Reports. 2020; 8(9):262-267. doi: 10.12691/ajmcr-8-9-2


Cardiac manifestations of COVID-19 include myocarditis, demand ischemia, myocardial infarction and arrhythmias with prothrombotic state being a major underlying pathogenetic mechanism. In this report we present a case of a 57-year-old, otherwise healthy, woman who presented with chest pain and nausea and was found to have an inferior wall ST-elevation myocardial infarction (STEMI) in the setting of an active COVID-19 infection. Angiography revealed tortuous coronary arteries with a 100% right coronary artery occlusion with high thrombus burden and normal left coronary system. In light of the available literature regarding the pro-thrombotic effects of this novel corona virus, we continued full dose anticoagulation with Enoxaparin after the cardiac catheterization and transitioned to rivaroxaban and we also continued the patient on dual antiplatelet therapy prior to discharge.

STEMI (ST-Elevation Myocardial Infarction) COVID-19 severe acute respiratory syndrome 2 (SARS-Cov-2) Percutaneous Coronary Intervention Fibrinolysis Thrombosis Anticoagulation

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 6


[1]  Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020.
[2]  Guo T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Epub 3-27-20.
[3]  Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020; 181(2): 271-280. e278.
[4]  Wood, Shelley. “COVID-19 Linked to 38% Drop in US STEMIs.”,, 10 Apr. 2020,
[5]  Recommendations From the Peking Union Medical College Hospital for the Management of Acute Myocardial Infarction During the COVID-19 Outbreak. Eur Heart J. 2020; Mar 31:
[6]  Mahmud, Ehtisham. “ACC, SCAI, ACEP Release Consensus Statement on Management of AMI Patients During COVID-19.” American College of Cardiology, 20 Apr. 2020, scai-acep-release-consensus-statement-on-management-of-ami- patients-during-covid-19.
[7]  Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020.
[8]  Fox, Sharon, et al. “Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans.” medRxiv preprint.
[9]  Klok FA, Kruip M, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020.
[10]  Mega, J, Eugene B, Stephen W et, al. "Rivaroxaban in Patients with a Recent Acute Coronary Syndrome" N Engl J Med 2012; 366: 9-19.