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促红细胞生成素α：冠状动脉血栓形成的一个原因。

Epoetin Alfa: A Cause of Coronary Artery Thrombosis.

作者信息

Siddiqui Muhammad Umer, Galumyan Yelena, Klein James, Naeem Zunaira, Schwarcz Aron

机构信息

Lakeview Medical Center, Marshfield Clinic, Rice Lake, WI, USA.

Englewood Hospital and Medical Center, Englewood, NJ, USA.

出版信息

Case Rep Cardiol. 2017;2017:9475180. doi: 10.1155/2017/9475180. Epub 2017 Oct 1.

DOI:10.1155/2017/9475180
PMID:29098093
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5643090/
Abstract

INTRODUCTION

Epoetin alfa is an erythrocyte-stimulating factor. We here present a case of an anemic patient, who was given epogen before a coronary artery bypass (CABG) surgery and developed periprocedural myocardial infarction. To our knowledge, there has been no previous case reported of epogen causing myocardial infarction.

CASE PRESENTATION

66-year-old female presented with substernal chest pain. EKG showed ST segment elevations in aVf and L-III. Patient underwent left heart catheterization (LHC) and had triple vessel disease. A bare metal stent was placed in RCA. Patient continued to have symptoms after discharge and presented to the ED again with these complaints. She underwent coronary artery bypass surgery (CABG). Before the procedure, patient's hemoglobin was 11.1 grams/deciliter and was given epogen to raise hemoglobin level. Postoperative day (POD) #1 patient had ST elevations in inferior and anterolateral leads. She was diagnosed with periprocedural myocardial infarction. Patient underwent repeat LHC, which identified obstruction of saphenous vein graft (SVG). Hypercoagulable workup was negative for any disease and the patient was diagnosed with epogen induced early graft occlusion.

CONCLUSION

Epogen administration can cause myocardial infarction and coronary artery thrombosis. We suggest that physicians use epogen very cautiously, especially in population who has underlying coronary artery disease.

摘要

引言

促红细胞生成素α是一种红细胞刺激因子。我们在此报告一例贫血患者，在冠状动脉搭桥手术（CABG）前使用了促红细胞生成素，并发生了围手术期心肌梗死。据我们所知，此前尚无促红细胞生成素导致心肌梗死的病例报道。

病例介绍

一名66岁女性因胸骨后胸痛就诊。心电图显示aVf和Ⅲ导联ST段抬高。患者接受了左心导管检查（LHC），发现三支血管病变。在右冠状动脉（RCA）置入了裸金属支架。出院后患者仍有症状，因这些症状再次就诊于急诊科。她接受了冠状动脉搭桥手术（CABG）。术前，患者血红蛋白为11.1克/分升，给予促红细胞生成素以提高血红蛋白水平。术后第1天，患者下壁和前侧壁导联出现ST段抬高。她被诊断为围手术期心肌梗死。患者接受了再次LHC，发现大隐静脉桥血管（SVG）阻塞。针对高凝状态的检查未发现任何疾病，患者被诊断为促红细胞生成素导致早期桥血管闭塞。

结论

使用促红细胞生成素可导致心肌梗死和冠状动脉血栓形成。我们建议医生非常谨慎地使用促红细胞生成素，尤其是在患有潜在冠状动脉疾病的人群中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/2c60b9ef581e/CRIC2017-9475180.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/f5fb3a4d3f3f/CRIC2017-9475180.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/0dc823bc57f1/CRIC2017-9475180.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/3a891e3efa45/CRIC2017-9475180.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/3855d5f53cc7/CRIC2017-9475180.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/2c60b9ef581e/CRIC2017-9475180.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/f5fb3a4d3f3f/CRIC2017-9475180.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/0dc823bc57f1/CRIC2017-9475180.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/3a891e3efa45/CRIC2017-9475180.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/3855d5f53cc7/CRIC2017-9475180.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/5643090/2c60b9ef581e/CRIC2017-9475180.005.jpg

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本文引用的文献

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