Drug-eluting stent thrombosis after cilostazol withdrawal in a patient previously treated with triple antiplatelet therapy

Antiplatelet therapy has been shown to reduce cardiac events after coronary stenting. However, despite aggressive antiplatelet therapy, stent thrombosis remains a serious complication of coronary stenting with drug-eluting stent (DES). Although several predictors for DES thrombosis have been suggested by investigators, this serious condition is still not completely preventable now. In particular, patients undergoing non-cardiac surgery or invasive procedures with bleeding risk may interrupt antiplatelet therapy and occasionally experience stent thrombosis. We report a case of DES thrombosis after cilostazol withdrawal for colonoscopic polypectomy in a patient previously treated with triple antiplatelet therapy. The patient presented with acute myocardial infarction but survived after successful emergency coronary revascularization. We discuss a plausible mechanism for DES thrombosis in the described case.