Intracoronary thrombus visualized by optical coherence tomography in a patient with antiphospholipid syndrome

A patient with a history of deep venous thrombosis on warfarin underwent coronary angiography and was found to have a red intracoronary thrombus in the mid left anterior descending artery by optical coherence tomography. Percutaneous coronary intervention was successfully performed. On discharge, the patient continued triple therapy with aspirin, clopidogrel, and apixaban for 30 days then discontinued aspirin. A hypercoagulable work up was notable for antiphospholipid syndrome and lifelong anticoagulation was recommended. The patient continued apixaban twice daily given recurrent thrombosis while on warfarin and was event free at 6-month follow up.