Massive subfascial hematoma after alteplase therapy for acute myocardial infarction

The authors report a case of a patient who received alteplase for acute myocardial infarction and developed spontaneous subfascial hematoma without any evidence of direct trauma. Subfascial hematoma remains a rare and self-limited complication of thrombolytic therapy. The development of cutaneous ecchymosis associated with a sudden fall in hemoglobin after the administration of alteplase should strongly suggest the possibility of diffuse subfascial hematoma. Physicians should be aware of the possible association between the use of alteplase and the development of subfascial hemorrhage.