Additional factors such as hypercoagulable states, cocaine use, essential thrombocytosis, oral contraceptive pills, tamoxifen, and clopidogrel resistance due to CYP2C19 polymorphism may contribute to the development of multivessel coronary artery thrombosis, though the exact cause often remains unknown [5]. The gene discussed is CYP2C19; the disease is essential thrombocythemia.