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A Myocardial Infarction During Intravenous Recombinant Tissue Plasminogen Activator Infusion for Evolving Ischemic

Sabine Fitzek1, Clemens Fitzek

  • 1Departments of *Neurology †Radiology and Neuroradiology, Asklepios Fachklinikum Brandenburg, Brandenburg, Germany.

The Neurologist
|September 17, 2015
PubMed
Abstract

Insights

Systemic thrombolysis with recombinant tissue-type plasminogen activator (rtPA) may cause embolic myocardial infarction (MI) by fragmenting cardiac thrombi. This rare complication highlights a serious risk associated with rtPA therapy.

Area of Science:

  • Cardiology
  • Neurology
  • Thrombolytic Therapy

Background:

  • Intracardiac thrombus formation increases stroke risk post-myocardial infarction (MI).
  • Recombinant tissue-type plasminogen activator (rtPA) is used for acute ischemic stroke and evolving myocardial infarction.

Observation:

  • A case of fatal myocardial infarction (MI) occurred immediately after initiating rtPA infusion for a middle cerebral artery stroke.
  • The patient was an 88-year-old woman.

Findings:

  • Systemic thrombolysis with rtPA is hypothesized to have caused fragmentation of an underlying cardiac thrombus.
  • The fragmented thrombus embolized, occluding a coronary artery and leading to MI.

Implications:

  • Embolic myocardial infarction is a rare but severe complication of rtPA therapy.
  • This case underscores the potential risks of systemic thrombolysis in patients with underlying cardiac conditions.

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