Pulmonary alveolar hemorrhage following thrombolytic therapy

Alveolar Hemorrhage Following Thrombolytic Therapy for Acute Myocardial Infarction: Two Case Reports and Literature Review

Alveolar hemorrhage (AH) is a heterogeneous clinical syndrome with a high mortality rate, characterized by extensive bleeding into the alveolar spaces. AH secondary to systemic thrombolysis treatment in the setting of acute myocardial infarction is an uncommon complication, but potentially fatal and can lead to acute respiratory failure. This entity is rarely reported in the literature. We report two cases of acute AH after intravenous thrombolysis for acute myocardial infarction, which could contribute to the literature on the subject, and discuss the risk factors as well as the clinical and radiological findings supporting the diagnosis. We overview also the rare previous published case reports in this context, and we contrast our findings with those reported in the literature.

Treatment of ST-Segment Elevation Myocardial Infarction During COVID-19 Pandemic

The number of cases of the coronavirus-induced disease-2019 (COVID-19) continues to increase exponentially worldwide. In this crisis situation, the management of ST-segment elevation myocardial infarction (STEMI) is challenging. In this review, we outline the risks and benefits of primary PCI vs. thrombolysis for STEMI. While thrombolysis may seem like a good choice, many patients have a contraindication and could end up using more resources. Also, with a high probability of the angiogram showing non-obstructed coronary arteries during acute infections, primary PCI should be the preferred strategy.

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During the COVID-19 pandemic, management of STSTEMI is challenging.

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Many patients have a contraindication to thrombolysis and end up using resources with this treatment.

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There is a high probability that an infected patient will show a normal angiogram.

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Primary PCI should be the preferred strategy in STEMI patients, with precautions.

Pulmonary haemorrhage following thrombolysis with streptokinase in myocardial infarction

Pulmonary haemorrhage is a rare but a life-threatening complication of thrombolytic therapy in patients with acute ST-elevation myocardial infarction (MI). It usually presents with anaemia, massive haemoptysis, acute-onset respiratory distress and diffuse bilateral lung infiltrates on imaging. We hereby describe two patients, who had pulmonary haemorrhage following streptokinase therapy for acute MI. The first patient improved with conservative treatment, while the second patient died due to respiratory failure. Streptokinase, a fibrin non-specific agent, is a widely used thrombolytic in low-income and middle-income countries. Pulmonary haemorrhage should be suspected in patients who develop sudden respiratory compromise after receiving thrombolytics, especially streptokinase. The management issues related to this uncommon life-threatening complication have been discussed in this article.

Diffuse alveolar hemorrhage following intravenous thrombolytic treatment in acute ischemic stroke: a case series

Diffuse alveolar hemorrhage (DAH) following fibrinolytic therapy is a rare but a life-threatening complication. In acute ischemic stroke (AIS), DAH as a complication was not reported following intravenous thrombolytic therapy (ITT). The demographic, clinical, radiologic, and prognostic data of 4 patients with AIS who developed DAH after ITT are presented in this case series, along with a literature review.