Author/Editor     Kirbiš, Simona; Sinkovič, Andreja
Title     Alveolarna krvavitev kot zaplet po kombiniranem zdravljenju z antiagregacijskimi in antikoagulantnimi zdravili pri primarni koronarni intervenciji pri bolniku z akutnim koronarnim sindromom z elevacijo ST veznice - prikaz primera
Translated title     Alveolar hemorrhage after treatment with combined antiplatelet and anticoagulation therapy before and during primary coronary intervention in acute coronary syndrome with ST elevation - a case report
Type     članek
Source     Acta medico-biotechnica
Vol. and No.     Letnik 2, št. 2
Publication year     2009
Volume     str. 48-51
ISSN     1855-5640
Language     eng
Abstract     Platelet inhibitior with aspirin and systemic anticoagulation with unfractioned heparin to reduce the incidence of recurrent thrombosis after primary coronary intervention (PCI) has been the standard of care for patients with acute coronary syndrome (ACS) with ST elevation for some time. Eptifibatide is the platelet membrane glycoprotein IIb/IIIa inhibitor that is often used. Bleeding complications occur most often at sites of vascular access and are more common in elderly patients. Alveolar hemorrhage with hemoptysis is a rare complication. We describe the case of a 43-year old smoker with an ST elevation myocardial infarction admitted for PCI. He was treated with standard anticoagulation and dual antiplatelet therapy before admission. Hemoptysis began approximately five minutes after the intracoronary application of eptifibatide at the end of the procedure. Supportive care including endotracheal intubation, mechanical ventilation, transfusion of packed red blood cells and reversal of all anticoagulation. Alveolar hemorrhage is life-threatening but adequate intensive supportive measures can be life-saving.
Summary     Z antiagregacijskim in antikoagulantnim zdravljenjem začnemo pri bolnikih z akutnim koronarnim sindromom (AKS) z elevacijo ST veznice že pred primarno koronarno intervencijo (PCI). Eptifibatid je zaviralec glikoproteinskih receptorjev IIb/IIIa na membrani trombocitov in ga pogosto uporabljamo skupaj s standardnim heparinom za preprečevanje tromboz po PCI. Krvavitve so zaplet po PCI in se najpogosteje pojavijo na vbodnem mestu in so pogostejše pri starejših bolnikih. Alveolama krvavitev je redek zaplet po kombiniranem zdravljenju z antiagregacijskimi in antikoagulantnimi zdravili. Opisan bo primer 43-letnega kadilca, ki se je zdravil zaradi miokardnega infarkta z dvigom veznice ST. Pred primarno PCI je prejel standardni heparin in dvojno antiagregacijsko terapijo. Kakšnih 5 minut po intrakoronarni aplikaciji eptifibatida so se pojavile hemoptize. Potrebna je bila intubacija, mehanična ventilacija, transfuzija koncentriranih eritrocitov in ukinitev vseh antikoagulantnih sredstev. Alveolarna krvavitev je življenje ogrožujoč zaplet po PCI in zahteva intenzivno in hitro zdravljenje.
Descriptors     HEMOPTYSIS
MYOCARDIAL INFARCTION
PLATELET AGGREGATION INHIBITORS
ANTICOAGULANTS