Primer Perkütan Koroner İşlem Sonrasında Klopidogrel Kullanımına Bağlı Difüz Alveoler Hemoraji

Yıl 2017, Cilt: 20 Sayı: 1, 63 - 65, 03.04.2017

Adnan Kaya , Sami İlhan Mustafa Adem Tatlısu Bayram Köroğlu Ahmet Öz

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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