Spinal Epidural Hematoma Following Tissue Plasminogen Activator and Heparinization for Acute Myocardial Infarction.

Abstract

SUMMARYThe case of a 43-year-old Taiwanese man who presented with spinal epidural hematoma following intravenous administration of recombinant tissue plasminogen activator (rTPA) and heparin therapy for acute myocardial infarction (AMI) is reported. Upper back pain and progressive neurological dysfunction ensued, secondary to spinal epidural hematoma with spinal cord compression. The patient did not recover neurologic function postsurgically, possibly because the operation was delayed. In conclusion, cardiologists should be alert to this rare, severe complication of rTPA and should perform early laminectomy (in ≤36 hours for those with complete deficit and in ≤48 hours for those with incomplete deficit) if possible. (Jpn Heart J 2002; 43: 417-421) Key words: Spinal epidural hematoma, Recombinant tissue plasminogen activator, Acute myocardial infarction THROMBOLYTIC therapy, in combination with heparin and aspirin, reestablishes coronary blood flow, reduces infarct size, improves left ventricular function, and reduces mortality following acute myocardial infarction (AMI). However, its use is limited by bleeding complications, especially intracranial hemorrhage. Spinal epidural hematoma associated with recombinant tissue plasminogen activator (rTPA) is very rare. We report here a case of spontaneous spinal epidural hematoma after combined rTPA and heparin therapy for AMI. CASE REPORTA 43-year-old Taiwanese man was admitted with acute inferior myocardial infarction. His coronary artery disease risk factors were smoking and uncontrolled hypertension. We administered thrombolytic therapy with recombinant From the

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…The majority of published reports involve spontaneous spinal or epidural hematomas after thrombolytic therapy. [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Recent cases involve thrombolysis for myocardial infarction. Bleeding has been reported at all spinal levels-cervical, thoracic, and lumbar.…”

Spinal subdural hematoma following tissue plasminogen activator treatment for acute ischemic stroke

“…In a paper of reviewing 106 cases of nontraumatic acute subdural hematoma which were reported in the international literatures between 1948 and 1998, the spinal subdural hematoma was associated with a bleeding disorder in 57 cases (54%), which was secondary to a defect in the hemostatic mechanism such as leukemia, hemophilia and thrombocytopenia in 20 cases and to anticoagulant therapy in 37 cases (35%) [17]. Recently some cases with spontaneous spinal epidural hematoma following intravenous thrombolysis for acute myocardial infarction have been reported [3][4][5][6][7][8][9][10][11][12][13]. However, there has been no report of spontaneous spinal subdural hematoma complicating thrombolytic therapy with rt-PA.…”

“…Symptomatic brain hemorrhage is the major risk associated with rt-PA treatment [2]. Some cases with spontaneous spinal epidural hematoma following intravenous thrombolysis for acute myocardial infarction have been reported [3][4][5][6][7][8][9][10][11][12][13]. However, there has been no report of spontaneous spinal hemorrhage, especially of the subdural type, complicating thrombolytic therapy with rt-PA for acute ischemic stroke.…”

Rosiglitazone Treatment of Diabetes Mellitus After Solid Organ Transplantation

“…We have shown that rtPA can be used safely, even in patients with recent bleeding, as long as there is no evidence of active bleeding during the treatment period. However, during treatment, we have to pay special attention not to miss the bleeding complication, which sometimes can be life threatening, such as central nervous system, gastrointestinal, or hepatic hemorrhage, as reported in the case of use in myocardial infarction (13)(14)(15). Accordingly, patients receiving rtPA treatment should be monitored closely for signs of bleeding to promptly institute intervention when necessary.…”