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A 53-year-old man was suffered from progressive effort angina. Coronary angiogram revealed complete obstruction of the left anterior descending artery with collaterals from posterior descending artery. The essential thrombocythemia was diagnosed from platelet count over 1,000,000/mm3 with bleeding tendency. And hyperlipidemia was not observed. After the platelet count was reduced into normal range by administration of Melphalan, coronary artery bypass grafting using the left internal thoracic artery was performed successfully. The main cause of his coronary artery disease was thought to be secondary to the essential thrombocythemia as his past history included cerebral infarction secondary to transient thrombus formation in the common carotid artery which was confirmed with cerebral angiography. He has been on melphalan, warfarin and dipyridamol therapy after the operation without chest symptom.
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