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Primer Perkütan Koroner İşlem Sonrasında Klopidogrel Kullanımına Bağlı Difüz Alveoler Hemoraji

Year 2017, Volume: 20 Issue: 1, 63 - 65, 03.04.2017

Abstract

Antitrombotik ilaçlar stabil anjina pektoris ve
akut koroner sendrom (kararsız angina pektoris, ST segment yükselmesiz miyokart
infarktüsü, ST segment yükselmeli miyokart infarktüsü) ile başvuran hastalar
için olmazsa olmaz ve en uygun ilaç tedavisidir. Antiplatelet ve antikoagülan
ilaçlar, akut koroner sendromda ölüm ve transmural miyokart infarktüsü
insidansını azalttı. Bu ilaçların trombüs oluşumunu engelleme ve trombositleri
inhibe etme mekanizması ile benzer şekilde kanama riskini artırırlar. Burada
göğüs ağrısı ile kliniğimize başvuran ve anterior miyokart infarktüsü tanısı
konulan bir olgu sunulmuştur. Hastaya rutin klopidogrel 600 mg ve asetilsalisilik
asit 300 mg oral başlandıktan sonra sol ön inen arter (LAD)’e predilatasyon ve
stent implantasyonu uygulandı. Klopidogrel alınmasından iki saat sonra koroner
yoğun bakım ünitesindeki takibinde kanlı balgam ve nefes darlığı gelişti.
Toraks yüksek rezonans bilgisayarlı tomografide difüz alveoler hemoraji
saptandı ve klopidogrel kesildi. Klopidogrele bağlı difüz alveoler hemoraji çok
nadir görülen bir komplikasyon olmakla birlikte bu ilacın ne kadar sıklıkta
kullanıldığı düşünülürse tanı ve tedavinin önemi ortaya çıkar.

References

  • 1. Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003;108:1682-7.
  • 2. Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, et al. Double-dose versus standard- dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010;376:1233-43.
  • 3. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/ American Heart Association task force on practice guidelines. J Am Coll Cardiol 2000;36:970-1062.
  • 4. Kushner FG, Hand M, Smith SC Jr, King SB, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/ AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2009;54:2205-41.
  • 5. Ali A, Hashem M, Rosman HS, Kazmouz G, Gardin JM, Schrieber TL. Use of platelet glycoprotein IIb/IIIa inhibitors and spontaneous pulmonary hemorrhage. J Invasive Cardiol 2003;15:186-8.
  • 6. Cohen SA, Effron MB. Abciximab and alveolar hemorrhage. N Engl J Med 1998;339:1861-3.
  • 7. Ikeda M, Tanaka H, Sadamatsu K. Diffuse alveolar hemorrhage as a complication of dual antiplatelet therapy for acute coronary syndrome. Cardiovasc Revasc Med 2011;12:407-11.
  • 8. Kilaru PK, Schweiger MJ, Kozman HA, Weil TR. Diffuse alveolar hemorrhage after clopidogrel use. J Invasive Cardiol 2001;13:535-7.
  • 9. Kim Y, Lim J, Lim J, Kim S, Jung T, Choi W. Pulmonary Alveolar Hemorrhage after Clopidogrel Use for ST Elevation Myocardial Infarction. Korean Circ J 2013;43:497-9.

Diffuse Alveolar Haemorrhage Due to Clopidogrel Use in a Patient Who Had Undergone Primary Percutaneous Intervention

Year 2017, Volume: 20 Issue: 1, 63 - 65, 03.04.2017

Abstract

Anti-thrombotic drugs are inevitable and
represent the most suitable drug therapy for patients presenting with stable
angina pectoris and acute coronary syndromes [unstable angina pectoris, non-ST
segment elevation myocardial infarction (NSTEMI) and STEMI]. Anti-platelet and
anti-coagulant drugs have reduced the incidence of death and transmural
myocardial infarction in patients with acute coronary syndromes (ACSs). Besides
their favourable effect in terms of inhibiting thrombus formation, they
increase the risk of bleeding by inhibiting platelets in ACS by the same
mechanism. Here we present a case of a patient who was admitted to our
institution with chest pain and who was diagnosed with anterior myocardial
infarction. After initiating anti-platelet therapy with 300 mg acetylsalicylic
acid orally and 600 mg clopidogrel orally, the patient underwent primary
percutaneous coronary intervention, which ended with predilatation and stent
implantation of the left anterior descending artery (LAD). After 2 hours of
clopidogrel ingestion, the patient presented with bloody sputum and dyspnoea in
the coronary care unit just after the intervention. Thoracic high-resonance
computed tomography (HRCT) revealed diffuse alveolar haemorrhage, and
clopidogrel was stopped. Diffuse alveolar haemorrhage due to clopidogrel is a
very rare major complication, and considering how commonly clopidogrel is used,
diagnosis and management of this complication are crucial.

References

  • 1. Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003;108:1682-7.
  • 2. Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, et al. Double-dose versus standard- dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010;376:1233-43.
  • 3. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/ American Heart Association task force on practice guidelines. J Am Coll Cardiol 2000;36:970-1062.
  • 4. Kushner FG, Hand M, Smith SC Jr, King SB, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/ AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2009;54:2205-41.
  • 5. Ali A, Hashem M, Rosman HS, Kazmouz G, Gardin JM, Schrieber TL. Use of platelet glycoprotein IIb/IIIa inhibitors and spontaneous pulmonary hemorrhage. J Invasive Cardiol 2003;15:186-8.
  • 6. Cohen SA, Effron MB. Abciximab and alveolar hemorrhage. N Engl J Med 1998;339:1861-3.
  • 7. Ikeda M, Tanaka H, Sadamatsu K. Diffuse alveolar hemorrhage as a complication of dual antiplatelet therapy for acute coronary syndrome. Cardiovasc Revasc Med 2011;12:407-11.
  • 8. Kilaru PK, Schweiger MJ, Kozman HA, Weil TR. Diffuse alveolar hemorrhage after clopidogrel use. J Invasive Cardiol 2001;13:535-7.
  • 9. Kim Y, Lim J, Lim J, Kim S, Jung T, Choi W. Pulmonary Alveolar Hemorrhage after Clopidogrel Use for ST Elevation Myocardial Infarction. Korean Circ J 2013;43:497-9.
There are 9 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Reports
Authors

Adnan Kaya

Sami İlhan This is me

Mustafa Adem Tatlısu This is me

Bayram Köroğlu This is me

Ahmet Öz This is me

Publication Date April 3, 2017
Published in Issue Year 2017 Volume: 20 Issue: 1

Cite

Vancouver Kaya A, İlhan S, Tatlısu MA, Köroğlu B, Öz A. Diffuse Alveolar Haemorrhage Due to Clopidogrel Use in a Patient Who Had Undergone Primary Percutaneous Intervention. Koşuyolu Heart Journal. 2017;20(1):63-5.