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Development of Alveolar Hemorrhage in a Patient with Acute Myocardial Infarction Complicated with Essential Thrombocythemia

Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy

Masahiro Ishikura, Akihiro Endo, Kaito Koshino, Yuzo Kagawa, Kazuaki Tanabe

Japan Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan

Am J Case Rep 2021; 22:e928409

DOI: 10.12659/AJCR.928409

Available online: 2020-12-26

Published: 2021-02-09


#928409

BACKGROUND: Essential thrombocythemia (ET) is a risk factor both for bleeding caused by abnormal platelet function and for thrombus formation caused by excessive platelet proliferation. We present a rare case of alveolar hemorrhage after dual antiplatelet therapy (DAPT), a serious bleeding complication of antithrombotic therapy, in a patient with an acute myocardial infarction complicated by ET.
CASE REPORT: A 75-year-old man was treated for ET. He experienced an acute myocardial infarction, and an emergent percutaneous coronary intervention was subsequently performed. DAPT was started just before stent implantation. Because a left ventricular thrombus was suspected in spite of DAPT, anticoagulant therapy with heparin was added. On day 7, a large amount of hemoptysis was observed, and alveolar hemorrhage was diagnosed. Although the antithrombotic treatment was de-escalated from DAPT to single antiplatelet therapy, no stent thrombosis or recurrence of alveolar hemorrhage was observed.
CONCLUSIONS: In ET patients, reduced platelet function due to thrombocytosis and strong antithrombotic therapy may cause an excessive bleeding risk. Switching from DAPT to antiplatelet monotherapy at the early stage of stent implantation is a treatment option in situations in which excessive bleeding risk is a concern.

Keywords: Hemorrhage, Platelet Aggregation Inhibitors, Risk Assessment, Thrombocythemia, Essential



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