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An autopsy case of intracranial hemorrhage during tissue plasminogen activator infusion
Insights
Sudden death occurred during tissue plasminogen activator (t-PA) infusion for heart attack. Autopsy revealed severe brain hemorrhage, highlighting a rare but critical risk of t-PA therapy.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality.
- Thrombolytic therapy, including tissue plasminogen activator (t-PA), is a critical treatment for AMI.
- Intracranial hemorrhage is a known, albeit rare, complication of thrombolytic therapy.
Observation:
- A 75-year-old male presented with symptoms of acute inferior myocardial infarction.
- The patient received intravenous heparin followed by a bolus and infusion of t-PA (Alteplase).
- Thirty minutes into the t-PA infusion, the patient experienced sudden loss of consciousness, convulsions, and cardiac arrest.
Findings:
- Autopsy revealed massive intracranial hemorrhage in the cerebrum and brain stem.
- This case represents the first reported instance of sudden death during t-PA infusion therapy for acute myocardial infarction.
- The findings suggest a potential for rapid and severe neurological complications during t-PA administration.
Implications:
- This case underscores the critical need for vigilant patient monitoring during t-PA infusion.
- It highlights the importance of considering the risk-benefit profile of thrombolytic therapy in individual patients.
- Further research may be warranted to identify predictive factors for severe hemorrhagic complications during t-PA treatment.
Abstract:
We describe an autopsy case of severe intracranial hemorrhage which occurred during the infusion of tissue plasminogen activator (t-PA) for acute myocardial infarction. A 75-year-old man was admitted with substernal chest pain of 3-h duration and electrocardiographic changes consistent with an acute inferior myocardial infarction. Physical examination was unremarkable, except for an initial blood pressure reading of 160/96 mmHg. The patient received 3,000 IU intravenous heparin followed by a 2.4 x 10(6) IU bolus dose of tissue plasminogen activator (t-PA) (Alteplase). This was followed by a drip infusion of 21.6 x 10(6) IU of t-PA over 1 h (total dose 41 mg). Thirty minutes after the infusion of t-PA was initiated, the patient suddenly lost consciousness and began to have violent convulsions, followed by cardiac arrest. Autopsy revealed massive hemorrhage in the bilateral cerebrum and brain stem. To our knowledge, this is the first case of sudden death during t-PA infusion therapy.