Pulmonary haemorrhage following thrombolysis with streptokinase in myocardial infarction

Abstract

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.

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

“… 20 It has been mentioned that certain potential cofactors may predispose to this complication such as underlying lung diseases (chronic obstructive pulmonary disease, prior emphysema), recent pneumonia, cardiac catheterization, arrhythmias requiring defibrillation shock or cardiopulmonary resuscitation, heart failure, and substances abuse as cocaine and tobacco. 21 Green et al 22 described that some patients with alveolar hemorrhage had capillaritis, suggesting an immune reaction since streptokinase is associated with a wide spectrum of allergic reactions, such as anaphylaxis, bronchospasm, and type III immune reactions. Tio et al 7 described the finding of antibodies against streptokinase in patients with HA treated with thrombolytics, which would support this theory.…”

“…Otherwise, artificial ventilation with the use of positive pressure would be in order. 21 Discontinuing antiplatelet and anticoagulation medication is necessary. 22 Antifibrinolytic agents, such as tranexamic acid was used in one case.…”

“…So far, only few cases have been reported in the literature. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] We hereby report two cases of acute alveolar hemorrhage complicating thrombolytic therapy in myocardial infarction, hoping to contribute to expand the literature data on this subject.…”

Production and market comparison of urokinase and streptokinase as effective and cheap fibrinolytic agents for treatment of cardiovascular diseases

“…Bleeding may occur spontaneously or at the puncture site. Intracranial hemorrhage and hemorrhage stroke are of significant concern in this case (Prasad, Singh, Kanabar, & Vijayvergiya, 2020). Different factors including tumor, aneurysm, infarction, bleeding diathesis, advanced age, uncontrolled hypertension, severe heart disease, low body weight, trauma, or surgical intervention in the cerebral system may increase the risk of bleeding (Aslanabadi, Safaie, Talebi, Dousti, & Entezari-Maleki, 2018).…”

Post thrombolytic alveolar hemorrhage: a case report

“…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 ].…”