[A man in his sixties with myocardial infarction, stent thrombosis and haemorrhage]

Tidsskr Nor Laegeforen. 2010 Mar 25;130(6):613-5. doi: 10.4045/tidsskr.09.0320.
[Article in Norwegian]

Abstract

A man in his sixties had acute ST-elevation myocardial infarction (treated with PCI [percutaneous coronary intervention] and antithrombotic medication) complicated by recurrent stent thrombosis. Excessive haematuria and discovery of a urinary bladder cancer complicated the antithrombotic treatment. Due to recurrent stent thrombosis the patient underwent a total of four PCIs and received the glycoprotein IIb/IIIa-inhibitor abciximab on two occasions. After the last administration of abciximab he developed excessive bleeding within an hour; a blood sample revealed severe thrombocytopenia (2 x 10(9)/l). Severe thrombocytopenia is a rare, but well-known complication to glycoprotein IIb/IIIa-inhibitor treatment and is most often seen after readministration of abciximab. The problem of recurrent coronary stent thrombosis was solved by aorto-coronary bypass surgery, which should always be considered in patients with recurrent stent thrombosis and complications to anti-thrombotic treatment. When bleeding occurs in connection with abciximab treatment, especially within the first month after previous treatment, severe thrombocytopenia should always be considered as a possible cause. Abciximab should be avoided in patients with a history of severe abciximab-related thrombocytopenia.

Publication types

  • Case Reports

MeSH terms

  • Abciximab
  • Angioplasty, Balloon
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Coronary Artery Bypass
  • Coronary Disease / diagnosis
  • Coronary Disease / therapy
  • Coronary Thrombosis / diagnosis
  • Coronary Thrombosis / drug therapy*
  • Coronary Thrombosis / etiology
  • Hematuria / complications
  • Hemorrhage / chemically induced*
  • Humans
  • Immunoglobulin Fab Fragments / adverse effects
  • Immunoglobulin Fab Fragments / therapeutic use
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / therapy*
  • Recurrence
  • Stents / adverse effects*
  • Thrombocytopenia / chemically induced
  • Urinary Bladder Neoplasms / complications

Substances

  • Antibodies, Monoclonal
  • Anticoagulants
  • Immunoglobulin Fab Fragments
  • Abciximab