Ishida Ryo, Nomura Tetsuya, Kojima Akiteru, Urakabe Yota, Enomoto Satoko, Nishikawa Susumu, Keira Natsuya, Matsubara Hiroaki, Tatsumi Tetsuya
Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan.
Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto, Japan.
J Cardiol Cases. 2009 Nov 8;1(1):e37-e41. doi: 10.1016/j.jccase.2009.07.003. eCollection 2010 Feb.
A 49-year-old woman complaining of anterior chest pain underwent emergent coronary angiogram and thrombotic obstruction in the proximal left anterior descending artery was discovered. Deployment of a bare metal stent recovered good coronary flow and congestive heart failure was soon relieved. However, on day 3 of hospitalization, chest radiography suddenly showed newly emergent bilateral pulmonary infiltration shadow mimicking congestive heart failure. Chest computed tomography and clinical findings suggested bilateral alveolar hemorrhage. The patient received dual antiplatelet therapy, aspirin 100 mg/day and clopidogrel 75 mg/day and continuous 15,000 U/day heparin infusion, after percutaneous coronary intervention. Therapies that minimize bleeding risk while maintaining an antithrombotic effect are required for patients with acute coronary syndrome (ACS). Due to concern about the increased risk of early stent thrombosis induced by discontinuation of antiplatelet therapy, we continued to administer dual antiplatelet therapy. Pulmonary hemorrhage complicated with ACS without abciximab is a rare clinical entity, and we successfully overcame this potentially life-threatening complication with conservative therapy.
一名49岁主诉前胸痛的女性接受了急诊冠状动脉造影，结果发现左前降支近端存在血栓性阻塞。植入裸金属支架后恢复了良好的冠状动脉血流，充血性心力衰竭很快得到缓解。然而，在住院第3天，胸部X线检查突然显示出新出现的双侧肺部浸润影，类似充血性心力衰竭。胸部计算机断层扫描和临床检查结果提示双侧肺泡出血。该患者在经皮冠状动脉介入治疗后接受了双重抗血小板治疗，即阿司匹林100毫克/天和氯吡格雷75毫克/天，以及肝素持续静脉输注15000单位/天。对于急性冠状动脉综合征（ACS）患者，需要采取在维持抗血栓作用的同时尽量降低出血风险的治疗方法。由于担心停用抗血小板治疗会增加早期支架血栓形成的风险，我们继续给予双重抗血小板治疗。无阿昔单抗的情况下，ACS并发肺出血是一种罕见的临床情况，我们通过保守治疗成功克服了这一潜在的危及生命的并发症。
