Primer Perkütan Koroner İşlem Sonrasında Klopidogrel Kullanımına Bağlı Difüz Alveoler Hemoraji

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.

Keywords

• Akut anteriyor miyokart infarktüsü,klopidogrel kullanımı,difüz alveoler hemoraji

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

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.

Keywords

• Acute anterior myocardial infarction,clopidogrel use,diffuse alveolar haemorrhage,complication

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