The two hit hypothesis in the antiphospholipid syndrome: Acute ischaemic heart involvement after valvular replacement despite anticoagulation in a patient with secondary APS

A patient with the antiphospholipid syndrome (APS), in whom a nonfatal myocardial infarction ensued after valvular heart replac ement despite anticoagulation, is described. The report further stresses the role of concomitant risk co-factors in inducing thrombotic events and points out that cardiosurgery might represent a potential major risk for myocardial ischaemic damage in APS.