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

Abstract

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.

Post thrombolytic alveolar hemorrhage: a case report

“…Diffuse alveolar hemorrhage is a life-threatening condition characterized by a symptomatic triad of dyspnea, hemoptysis and anemia in addition to diffuse bilateral lung infiltrates on radiological studies [ 1 , 3 , 4 ]. The clinical course of the disease have a wide spectrum from asymptomatic mild cases to abrupt fetal cases of severe respiratory distress, hemodynamic instability and death [ 1 , 3 ].…”

“…Thrombolytic therapy is the mainstay of revascularization of acute STEMI when P-PCI cannot be performed within 120 minutes [ 1 , 2 ]. The main considerations of these agents remain the bleeding risk and allergic reactions.…”

“…However, frank AH is an extremely rare entity. Ben Murad et al review of the English medical literature revealed only 22 patients until date [ 1 ]. Surprisingly all 23 patients (including ours) were males, which posted the male gander as a predisposing factor [ 1 ].…”

“…Alveolar hemorrhage (AH) is a life-threatening condition characterized by intra-alveolar bleeding. AH usually presents with anemia, hemoptysis, and dyspnea that can lead to respiratory distress syndrome and death [ 1–3 ].…”

“…Thrombolytic therapy is the mainstay of revascularization in patients with acute ST-elevation myocardial infarction (STEMI) who are not eligible for primary percutaneous coronary intervention (P-PCI) [ 1 , 2 ]. However, it is associated with a non-negligible risk of bleeding involving the visceral organs such as gastrointestinal and genitourinary tracts, vascular access sites and intracranial hemorrhage [ 1 ].…”