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Tissue plasminogen activator associated pulmonary hemorrhage in patient with ACTA2-associated arteriopathy

Travis G Hughes1, Mark A Wurth2, Mary B Sheppard3,4,5

  • 1Division of Vascular and Endovascular Surgery, University of Kentucky, Lexington, KY.

Journal of Vascular Surgery Cases and Innovative Techniques
|September 23, 2024
PubMed

Insights

A rare complication, pulmonary hemorrhage, occurred after tissue plasminogen activator (tPA) treatment in a boy with an ACTA2 gene variant. This suggests ACTA2 variants may increase risk for tPA-related pulmonary bleeding.

Area of Science:

  • Cardiovascular Medicine
  • Genetics
  • Pulmonology

Background:

  • Tissue plasminogen activator (tPA) is a thrombolytic agent used to treat thrombotic events.
  • Rarely, tPA administration can lead to serious complications such as pulmonary hemorrhage.
  • Genetic factors may influence the risk of adverse events following tPA therapy.

Observation:

  • A 15-year-old male presented with thrombosis of a right brachial artery aneurysm.
  • The patient received tPA for treatment of the arterial thrombosis.
  • Following tPA administration, the patient developed pulmonary hemorrhage.

Findings:

  • The patient was found to have a heterozygous pathogenic variant in the ACTA2 gene.
  • The ACTA2 gene is associated with vascular abnormalities.
  • Pulmonary hemorrhage occurred subsequent to tPA treatment in this patient with an ACTA2 variant.

Implications:

  • Pathogenic variants in ACTA2 may predispose individuals to pulmonary hemorrhage after tPA administration.
  • Underlying pulmonary abnormalities associated with ACTA2 variants could be a risk factor.
  • Further research is warranted to elucidate the relationship between ACTA2 variants and tPA-induced pulmonary bleeding.
Keywords:
ACTA2Brachial artery aneurysmPulmonary hemorrhageThrombosis

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