Pulmonary alveolar hemorrhage mimicking a pneumopathy: a rare complication of dual antiplatelet therapy for ST elevation myocardial infarction

Abstract

Diffuse alveolar hemorrhage after percutaneous coronary intervention (PCI) is a rare complication. The diagnosis is difficult and can mimic by clinical and radiological features other diagnosis as pneumopathy. We herein report the case of a 63-year-old female admitted to the hospital for ST elevation myocardial infarction. The patient underwent PCI and received dual antiplatelet therapy. Four days later, she developed dyspnea, hemoptysis and fever. Clinical, radiological and biological findings oriented to a pneumopathy and the patient received the treatment for it. Later and because of the non improvement, a thoracic computed tomography was performed and revealed patchy areas of ground-glass opacity consistent with a diffuse pulmonary hemorrhage. The combination therapy with aspirin and clopidogrel was therefore the most likely cause. Although the dual antiplatelet combination reduces systemic ischemic events after PCI, it is associated with increased risk of nonfatal and sometimes fatal bleeding. Hence the necessity of close and careful observation to watch for possible fatal complications.

Diffuse Alveolar Hemorrhage: An Unexpected Effect After Taking Acetylsalicylic Acid

“…In cases of drug-induced DAH, it is recommended to discontinue the drug [1]. Many drugs have been associated with DAH, including anticoagulants [4][5][6], thrombolytic agents [7], and antiplatelet agents [8][9][10]. Aspirin® has traditionally been used as an analgesic and anti-inflammatory drug.…”