[Biventricular thrombi dissolution and antibody development with lepirudin therapy]

Area of Science:

• Cardiology
• Hematology
• Immunology

Background:

• Dilatative cardiomyopathy can lead to severe heart failure (NYHA IV) with biventricular thrombi.
• Effective anticoagulation is crucial for managing such thromboembolic risks.

Observation:

• A patient with severe heart failure and biventricular thrombi showed symptom improvement with heart failure medication.
• Anticoagulation with lepirudin successfully dissolved biventricular thrombi within 17 days.

Findings:

• Lepirudin, a potent anticoagulant, induced severe hemorrhagic complications including petechial bleedings, hemoptysis, and gross hematuria.
• Despite cessation of anticoagulation and supportive measures, the patient developed a fatal subarachnoid hemorrhage.
• This case suggests a rare immunological reaction involving prothrombin activation and fibrin formation as a cause of lepirudin-induced bleeding.

Implications:

• Lepirudin can be highly effective but carries a risk of severe, potentially fatal hemorrhagic side effects.
• Rare immunological reactions should be considered in cases of unexplained severe bleeding during lepirudin therapy.
• This case underscores the complex interplay between anticoagulation, thrombosis, and hemostasis in advanced heart failure.